expert interview in qualitative research

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• Published: 15 September 2022

Interviews in the social sciences

• Eleanor Knott   ORCID: orcid.org/0000-0002-9131-3939 1 ,
• Aliya Hamid Rao   ORCID: orcid.org/0000-0003-0674-4206 1 ,
• Kate Summers   ORCID: orcid.org/0000-0001-9964-0259 1 &
• Chana Teeger   ORCID: orcid.org/0000-0002-5046-8280 1  

Nature Reviews Methods Primers volume  2 , Article number:  73 ( 2022 ) Cite this article

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In-depth interviews are a versatile form of qualitative data collection used by researchers across the social sciences. They allow individuals to explain, in their own words, how they understand and interpret the world around them. Interviews represent a deceptively familiar social encounter in which people interact by asking and answering questions. They are, however, a very particular type of conversation, guided by the researcher and used for specific ends. This dynamic introduces a range of methodological, analytical and ethical challenges, for novice researchers in particular. In this Primer, we focus on the stages and challenges of designing and conducting an interview project and analysing data from it, as well as strategies to overcome such challenges.

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Introduction.

In-depth interviews are a qualitative research method that follow a deceptively familiar logic of human interaction: they are conversations where people talk with each other, interact and pose and answer questions 1 . An interview is a specific type of interaction in which — usually and predominantly — a researcher asks questions about someone’s life experience, opinions, dreams, fears and hopes and the interview participant answers the questions 1 .

Interviews will often be used as a standalone method or combined with other qualitative methods, such as focus groups or ethnography, or quantitative methods, such as surveys or experiments. Although interviewing is a frequently used method, it should not be viewed as an easy default for qualitative researchers 2 . Interviews are also not suited to answering all qualitative research questions, but instead have specific strengths that should guide whether or not they are deployed in a research project. Whereas ethnography might be better suited to trying to observe what people do, interviews provide a space for extended conversations that allow the researcher insights into how people think and what they believe. Quantitative surveys also give these kinds of insights, but they use pre-determined questions and scales, privileging breadth over depth and often overlooking harder-to-reach participants.

In-depth interviews can take many different shapes and forms, often with more than one participant or researcher. For example, interviews might be highly structured (using an almost survey-like interview guide), entirely unstructured (taking a narrative and free-flowing approach) or semi-structured (using a topic guide ). Researchers might combine these approaches within a single project depending on the purpose of the interview and the characteristics of the participant. Whatever form the interview takes, researchers should be mindful of the dynamics between interviewer and participant and factor these in at all stages of the project.

In this Primer, we focus on the most common type of interview: one researcher taking a semi-structured approach to interviewing one participant using a topic guide. Focusing on how to plan research using interviews, we discuss the necessary stages of data collection. We also discuss the stages and thought-process behind analysing interview material to ensure that the richness and interpretability of interview material is maintained and communicated to readers. The Primer also tracks innovations in interview methods and discusses the developments we expect over the next 5–10 years.

We wrote this Primer as researchers from sociology, social policy and political science. We note our disciplinary background because we acknowledge that there are disciplinary differences in how interviews are approached and understood as a method.

Experimentation

Here we address research design considerations and data collection issues focusing on topic guide construction and other pragmatics of the interview. We also explore issues of ethics and reflexivity that are crucial throughout the research project.

Research design

Participant selection.

Participants can be selected and recruited in various ways for in-depth interview studies. The researcher must first decide what defines the people or social groups being studied. Often, this means moving from an abstract theoretical research question to a more precise empirical one. For example, the researcher might be interested in how people talk about race in contexts of diversity. Empirical settings in which this issue could be studied could include schools, workplaces or adoption agencies. The best research designs should clearly explain why the particular setting was chosen. Often there are both intrinsic and extrinsic reasons for choosing to study a particular group of people at a specific time and place 3 . Intrinsic motivations relate to the fact that the research is focused on an important specific social phenomenon that has been understudied. Extrinsic motivations speak to the broader theoretical research questions and explain why the case at hand is a good one through which to address them empirically.

Next, the researcher needs to decide which types of people they would like to interview. This decision amounts to delineating the inclusion and exclusion criteria for the study. The criteria might be based on demographic variables, like race or gender, but they may also be context-specific, for example, years of experience in an organization. These should be decided based on the research goals. Researchers should be clear about what characteristics would make an individual a candidate for inclusion in the study (and what would exclude them).

The next step is to identify and recruit the study’s sample . Usually, many more people fit the inclusion criteria than can be interviewed. In cases where lists of potential participants are available, the researcher might want to employ stratified sampling , dividing the list by characteristics of interest before sampling.

When there are no lists, researchers will often employ purposive sampling . Many researchers consider purposive sampling the most useful mode for interview-based research since the number of interviews to be conducted is too small to aim to be statistically representative 4 . Instead, the aim is not breadth, via representativeness, but depth via rich insights about a set of participants. In addition to purposive sampling, researchers often use snowball sampling . Both purposive and snowball sampling can be combined with quota sampling . All three types of sampling aim to ensure a variety of perspectives within the confines of a research project. A goal for in-depth interview studies can be to sample for range, being mindful of recruiting a diversity of participants fitting the inclusion criteria.

Study design

The total number of interviews depends on many factors, including the population studied, whether comparisons are to be made and the duration of interviews. Studies that rely on quota sampling where explicit comparisons are made between groups will require a larger number of interviews than studies focused on one group only. Studies where participants are interviewed over several hours, days or even repeatedly across years will tend to have fewer participants than those that entail a one-off engagement.

Researchers often stop interviewing when new interviews confirm findings from earlier interviews with no new or surprising insights (saturation) 4 , 5 , 6 . As a criterion for research design, saturation assumes that data collection and analysis are happening in tandem and that researchers will stop collecting new data once there is no new information emerging from the interviews. This is not always possible. Researchers rarely have time for systematic data analysis during data collection and they often need to specify their sample in funding proposals prior to data collection. As a result, researchers often draw on existing reports of saturation to estimate a sample size prior to data collection. These suggest between 12 and 20 interviews per category of participant (although researchers have reported saturation with samples that are both smaller and larger than this) 7 , 8 , 9 . The idea of saturation has been critiqued by many qualitative researchers because it assumes that meaning inheres in the data, waiting to be discovered — and confirmed — once saturation has been reached 7 . In-depth interview data are often multivalent and can give rise to different interpretations. The important consideration is, therefore, not merely how many participants are interviewed, but whether one’s research design allows for collecting rich and textured data that provide insight into participants’ understandings, accounts, perceptions and interpretations.

Sometimes, researchers will conduct interviews with more than one participant at a time. Researchers should consider the benefits and shortcomings of such an approach. Joint interviews may, for example, give researchers insight into how caregivers agree or debate childrearing decisions. At the same time, they may be less adaptive to exploring aspects of caregiving that participants may not wish to disclose to each other. In other cases, there may be more than one person interviewing each participant, such as when an interpreter is used, and so it is important to consider during the research design phase how this might shape the dynamics of the interview.

Data collection

Semi-structured interviews are typically organized around a topic guide comprised of an ordered set of broad topics (usually 3–5). Each topic includes a set of questions that form the basis of the discussion between the researcher and participant (Fig.  1 ). These topics are organized around key concepts that the researcher has identified (for example, through a close study of prior research, or perhaps through piloting a small, exploratory study) 5 .

a | Elaborated topics the researcher wants to cover in the interview and example questions. b | An example topic arc. Using such an arc, one can think flexibly about the order of topics. Considering the main question for each topic will help to determine the best order for the topics. After conducting some interviews, the researcher can move topics around if a different order seems to make sense.

Topic guide

One common way to structure a topic guide is to start with relatively easy, open-ended questions (Table  1 ). Opening questions should be related to the research topic but broad and easy to answer, so that they help to ease the participant into conversation.

After these broad, opening questions, the topic guide may move into topics that speak more directly to the overarching research question. The interview questions will be accompanied by probes designed to elicit concrete details and examples from the participant (see Table  1 ).

Abstract questions are often easier for participants to answer once they have been asked more concrete questions. In our experience, for example, questions about feelings can be difficult for some participants to answer, but when following probes concerning factual experiences these questions can become less challenging. After the main themes of the topic guide have been covered, the topic guide can move onto closing questions. At this stage, participants often repeat something they have said before, although they may sometimes introduce a new topic.

Interviews are especially well suited to gaining a deeper insight into people’s experiences. Getting these insights largely depends on the participants’ willingness to talk to the researcher. We recommend designing open-ended questions that are more likely to elicit an elaborated response and extended reflection from participants rather than questions that can be answered with yes or no.

Questions should avoid foreclosing the possibility that the participant might disagree with the premise of the question. Take for example the question: “Do you support the new family-friendly policies?” This question minimizes the possibility of the participant disagreeing with the premise of this question, which assumes that the policies are ‘family-friendly’ and asks for a yes or no answer. Instead, asking more broadly how a participant feels about the specific policy being described as ‘family-friendly’ (for example, a work-from-home policy) allows them to express agreement, disagreement or impartiality and, crucially, to explain their reasoning 10 .

For an uninterrupted interview that will last between 90 and 120 minutes, the topic guide should be one to two single-spaced pages with questions and probes. Ideally, the researcher will memorize the topic guide before embarking on the first interview. It is fine to carry a printed-out copy of the topic guide but memorizing the topic guide ahead of the interviews can often make the interviewer feel well prepared in guiding the participant through the interview process.

Although the topic guide helps the researcher stay on track with the broad areas they want to cover, there is no need for the researcher to feel tied down by the topic guide. For instance, if a participant brings up a theme that the researcher intended to discuss later or a point the researcher had not anticipated, the researcher may well decide to follow the lead of the participant. The researcher’s role extends beyond simply stating the questions; it entails listening and responding, making split-second decisions about what line of inquiry to pursue and allowing the interview to proceed in unexpected directions.

Optimizing the interview

The ideal place for an interview will depend on the study and what is feasible for participants. Generally, a place where the participant and researcher can both feel relaxed, where the interview can be uninterrupted and where noise or other distractions are limited is ideal. But this may not always be possible and so the researcher needs to be prepared to adapt their plans within what is feasible (and desirable for participants).

Another key tool for the interview is a recording device (assuming that permission for recording has been given). Recording can be important to capture what the participant says verbatim. Additionally, it can allow the researcher to focus on determining what probes and follow-up questions they want to pursue rather than focusing on taking notes. Sometimes, however, a participant may not allow the researcher to record, or the recording may fail. If the interview is not recorded we suggest that the researcher takes brief notes during the interview, if feasible, and then thoroughly make notes immediately after the interview and try to remember the participant’s facial expressions, gestures and tone of voice. Not having a recording of an interview need not limit the researcher from getting analytical value from it.

As soon as possible after each interview, we recommend that the researcher write a one-page interview memo comprising three key sections. The first section should identify two to three important moments from the interview. What constitutes important is up to the researcher’s discretion 9 . The researcher should note down what happened in these moments, including the participant’s facial expressions, gestures, tone of voice and maybe even the sensory details of their surroundings. This exercise is about capturing ethnographic detail from the interview. The second part of the interview memo is the analytical section with notes on how the interview fits in with previous interviews, for example, where the participant’s responses concur or diverge from other responses. The third part consists of a methodological section where the researcher notes their perception of their relationship with the participant. The interview memo allows the researcher to think critically about their positionality and practice reflexivity — key concepts for an ethical and transparent research practice in qualitative methodology 11 , 12 .

Ethics and reflexivity

All elements of an in-depth interview can raise ethical challenges and concerns. Good ethical practice in interview studies often means going beyond the ethical procedures mandated by institutions 13 . While discussions and requirements of ethics can differ across disciplines, here we focus on the most pertinent considerations for interviews across the research process for an interdisciplinary audience.

Ethical considerations prior to interview

Before conducting interviews, researchers should consider harm minimization, informed consent, anonymity and confidentiality, and reflexivity and positionality. It is important for the researcher to develop their own ethical sensitivities and sensibilities by gaining training in interview and qualitative methods, reading methodological and field-specific texts on interviews and ethics and discussing their research plans with colleagues.

Researchers should map the potential harm to consider how this can be minimized. Primarily, researchers should consider harm from the participants’ perspective (Box  1 ). But, it is also important to consider and plan for potential harm to the researcher, research assistants, gatekeepers, future researchers and members of the wider community 14 . Even the most banal of research topics can potentially pose some form of harm to the participant, researcher and others — and the level of harm is often highly context-dependent. For example, a research project on religion in society might have very different ethical considerations in a democratic versus authoritarian research context because of how openly or not such topics can be discussed and debated 15 .

The researcher should consider how they will obtain and record informed consent (for example, written or oral), based on what makes the most sense for their research project and context 16 . Some institutions might specify how informed consent should be gained. Regardless of how consent is obtained, the participant must be made aware of the form of consent, the intentions and procedures of the interview and potential forms of harm and benefit to the participant or community before the interview commences. Moreover, the participant must agree to be interviewed before the interview commences. If, in addition to interviews, the study contains an ethnographic component, it is worth reading around this topic (see, for example, Murphy and Dingwall 17 ). Informed consent must also be gained for how the interview will be recorded before the interview commences. These practices are important to ensure the participant is contributing on a voluntary basis. It is also important to remind participants that they can withdraw their consent at any time during the interview and for a specified period after the interview (to be decided with the participant). The researcher should indicate that participants can ask for anything shared to be off the record and/or not disseminated.

In terms of anonymity and confidentiality, it is standard practice when conducting interviews to agree not to use (or even collect) participants’ names and personal details that are not pertinent to the study. Anonymizing can often be the safer option for minimizing harm to participants as it is hard to foresee all the consequences of de-anonymizing, even if participants agree. Regardless of what a researcher decides, decisions around anonymity must be agreed with participants during the process of gaining informed consent and respected following the interview.

Although not all ethical challenges can be foreseen or planned for 18 , researchers should think carefully — before the interview — about power dynamics, participant vulnerability, emotional state and interactional dynamics between interviewer and participant, even when discussing low-risk topics. Researchers may then wish to plan for potential ethical issues, for example by preparing a list of relevant organizations to which participants can be signposted. A researcher interviewing a participant about debt, for instance, might prepare in advance a list of debt advice charities, organizations and helplines that could provide further support and advice. It is important to remember that the role of an interviewer is as a researcher rather than as a social worker or counsellor because researchers may not have relevant and requisite training in these other domains.

Box 1 Mapping potential forms of harm

Social: researchers should avoid causing any relational detriment to anyone in the course of interviews, for example, by sharing information with other participants or causing interview participants to be shunned or mistreated by their community as a result of participating.

Economic: researchers should avoid causing financial detriment to anyone, for example, by expecting them to pay for transport to be interviewed or to potentially lose their job as a result of participating.

Physical: researchers should minimize the risk of anyone being exposed to violence as a result of the research both from other individuals or from authorities, including police.

Psychological: researchers should minimize the risk of causing anyone trauma (or re-traumatization) or psychological anguish as a result of the research; this includes not only the participant but importantly the researcher themselves and anyone that might read or analyse the transcripts, should they contain triggering information.

Political: researchers should minimize the risk of anyone being exposed to political detriment as a result of the research, such as retribution.

Professional/reputational: researchers should minimize the potential for reputational damage to anyone connected to the research (this includes ensuring good research practices so that any researchers involved are not harmed reputationally by being involved with the research project).

The task here is not to map exhaustively the potential forms of harm that might pertain to a particular research project (that is the researcher’s job and they should have the expertise most suited to mapping such potential harms relative to the specific project) but to demonstrate the breadth of potential forms of harm.

Ethical considerations post-interview

Researchers should consider how interview data are stored, analysed and disseminated. If participants have been offered anonymity and confidentiality, data should be stored in a way that does not compromise this. For example, researchers should consider removing names and any other unnecessary personal details from interview transcripts, password-protecting and encrypting files and using pseudonyms to label and store all interview data. It is also important to address where interview data are taken (for example, across borders in particular where interview data might be of interest to local authorities) and how this might affect the storage of interview data.

Examining how the researcher will represent participants is a paramount ethical consideration both in the planning stages of the interview study and after it has been conducted. Dissemination strategies also need to consider questions of anonymity and representation. In small communities, even if participants are given pseudonyms, it might be obvious who is being described. Anonymizing not only the names of those participating but also the research context is therefore a standard practice 19 . With particularly sensitive data or insights about the participant, it is worth considering describing participants in a more abstract way rather than as specific individuals. These practices are important both for protecting participants’ anonymity but can also affect the ability of the researcher and others to return ethically to the research context and similar contexts 20 .

Reflexivity and positionality

Reflexivity and positionality mean considering the researcher’s role and assumptions in knowledge production 13 . A key part of reflexivity is considering the power relations between the researcher and participant within the interview setting, as well as how researchers might be perceived by participants. Further, researchers need to consider how their own identities shape the kind of knowledge and assumptions they bring to the interview, including how they approach and ask questions and their analysis of interviews (Box  2 ). Reflexivity is a necessary part of developing ethical sensibility as a researcher by adapting and reflecting on how one engages with participants. Participants should not feel judged, for example, when they share information that researchers might disagree with or find objectionable. How researchers deal with uncomfortable moments or information shared by participants is at their discretion, but they should consider how they will react both ahead of time and in the moment.

Researchers can develop their reflexivity by considering how they themselves would feel being asked these interview questions or represented in this way, and then adapting their practice accordingly. There might be situations where these questions are not appropriate in that they unduly centre the researchers’ experiences and worldview. Nevertheless, these prompts can provide a useful starting point for those beginning their reflexive journey and developing an ethical sensibility.

Reflexivity and ethical sensitivities require active reflection throughout the research process. For example, researchers should take care in interview memos and their notes to consider their assumptions, potential preconceptions, worldviews and own identities prior to and after interviews (Box  2 ). Checking in with assumptions can be a way of making sure that researchers are paying close attention to their own theoretical and analytical biases and revising them in accordance with what they learn through the interviews. Researchers should return to these notes (especially when analysing interview material), to try to unpack their own effects on the research process as well as how participants positioned and engaged with them.

Box 2 Aspects to reflect on reflexively

For reflexive engagement, and understanding the power relations being co-constructed and (re)produced in interviews, it is necessary to reflect, at a minimum, on the following.

Ethnicity, race and nationality, such as how does privilege stemming from race or nationality operate between the researcher, the participant and research context (for example, a researcher from a majority community may be interviewing a member of a minority community)

Gender and sexuality, see above on ethnicity, race and nationality

Social class, and in particular the issue of middle-class bias among researchers when formulating research and interview questions

Economic security/precarity, see above on social class and thinking about the researcher’s relative privilege and the source of biases that stem from this

Educational experiences and privileges, see above

Disciplinary biases, such as how the researcher’s discipline/subfield usually approaches these questions, possibly normalizing certain assumptions that might be contested by participants and in the research context

Political and social values

Lived experiences and other dimensions of ourselves that affect and construct our identity as researchers

In this section, we discuss the next stage of an interview study, namely, analysing the interview data. Data analysis may begin while more data are being collected. Doing so allows early findings to inform the focus of further data collection, as part of an iterative process across the research project. Here, the researcher is ultimately working towards achieving coherence between the data collected and the findings produced to answer successfully the research question(s) they have set.

The two most common methods used to analyse interview material across the social sciences are thematic analysis 21 and discourse analysis 22 . Thematic analysis is a particularly useful and accessible method for those starting out in analysis of qualitative data and interview material as a method of coding data to develop and interpret themes in the data 21 . Discourse analysis is more specialized and focuses on the role of discourse in society by paying close attention to the explicit, implicit and taken-for-granted dimensions of language and power 22 , 23 . Although thematic and discourse analysis are often discussed as separate techniques, in practice researchers might flexibly combine these approaches depending on the object of analysis. For example, those intending to use discourse analysis might first conduct thematic analysis as a way to organize and systematize the data. The object and intention of analysis might differ (for example, developing themes or interrogating language), but the questions facing the researcher (such as whether to take an inductive or deductive approach to analysis) are similar.

Preparing data

Data preparation is an important step in the data analysis process. The researcher should first determine what comprises the corpus of material and in what form it will it be analysed. The former refers to whether, for example, alongside the interviews themselves, analytic memos or observational notes that may have been taken during data collection will also be directly analysed. The latter refers to decisions about how the verbal/audio interview data will be transformed into a written form, making it suitable for processes of data analysis. Typically, interview audio recordings are transcribed to produce a written transcript. It is important to note that the process of transcription is one of transformation. The verbal interview data are transformed into a written transcript through a series of decisions that the researcher must make. The researcher should consider the effect of mishearing what has been said or how choosing to punctuate a sentence in a particular way will affect the final analysis.

Box  3 shows an example transcript excerpt from an interview with a teacher conducted by Teeger as part of her study of history education in post-apartheid South Africa 24 (Box  3 ). Seeing both the questions and the responses means that the reader can contextualize what the participant (Ms Mokoena) has said. Throughout the transcript the researcher has used square brackets, for example to indicate a pause in speech, when Ms Mokoena says “it’s [pause] it’s a difficult topic”. The transcription choice made here means that we see that Ms Mokoena has taken time to pause, perhaps to search for the right words, or perhaps because she has a slight apprehension. Square brackets are also included as an overt act of communication to the reader. When Ms Mokoena says “ja”, the English translation (“yes”) of the word in Afrikaans is placed in square brackets to ensure that the reader can follow the meaning of the speech.

Decisions about what to include when transcribing will be hugely important for the direction and possibilities of analysis. Researchers should decide what they want to capture in the transcript, based on their analytic focus. From a (post)positivist perspective 25 , the researcher may be interested in the manifest content of the interview (such as what is said, not how it is said). In that case, they may choose to transcribe intelligent verbatim . From a constructivist perspective 25 , researchers may choose to record more aspects of speech (including, for example, pauses, repetitions, false starts, talking over one another) so that these features can be analysed. Those working from this perspective argue that to recognize the interactional nature of the interview setting adequately and to avoid misinterpretations, features of interaction (pauses, overlaps between speakers and so on) should be preserved in transcription and therefore in the analysis 10 . Readers interested in learning more should consult Potter and Hepburn’s summary of how to present interaction through transcription of interview data 26 .

The process of analysing semi-structured interviews might be thought of as a generative rather than an extractive enterprise. Findings do not already exist within the interview data to be discovered. Rather, researchers create something new when analysing the data by applying their analytic lens or approach to the transcripts. At a high level, there are options as to what researchers might want to glean from their interview data. They might be interested in themes, whereby they identify patterns of meaning across the dataset 21 . Alternatively, they may focus on discourse(s), looking to identify how language is used to construct meanings and therefore how language reinforces or produces aspects of the social world 27 . Alternatively, they might look at the data to understand narrative or biographical elements 28 .

A further overarching decision to make is the extent to which researchers bring predetermined framings or understandings to bear on their data, or instead begin from the data themselves to generate an analysis. One way of articulating this is the extent to which researchers take a deductive approach or an inductive approach to analysis. One example of a truly inductive approach is grounded theory, whereby the aim of the analysis is to build new theory, beginning with one’s data 6 , 29 . In practice, researchers using thematic and discourse analysis often combine deductive and inductive logics and describe their process instead as iterative (referred to also as an abductive approach ) 30 , 31 . For example, researchers may decide that they will apply a given theoretical framing, or begin with an initial analytic framework, but then refine or develop these once they begin the process of analysis.

Box 3 Excerpt of interview transcript (from Teeger 24 )

Interviewer : Maybe you could just start by talking about what it’s like to teach apartheid history.

Ms Mokoena : It’s a bit challenging. You’ve got to accommodate all the kids in the class. You’ve got to be sensitive to all the racial differences. You want to emphasize the wrongs that were done in the past but you also want to, you know, not to make kids feel like it’s their fault. So you want to use the wrongs of the past to try and unite the kids …

Interviewer : So what kind of things do you do?

Ms Mokoena : Well I normally highlight the fact that people that were struggling were not just the blacks, it was all the races. And I give examples of the people … from all walks of life, all races, and highlight how they suffered as well as a result of apartheid, particularly the whites… . What I noticed, particularly my first year of teaching apartheid, I noticed that the black kids made the others feel responsible for what happened… . I had a lot of fights…. A lot of kids started hating each other because, you know, the others are white and the others were black. And they started saying, “My mother is a domestic worker because she was never allowed an opportunity to get good education.” …

Interviewer : I didn’t see any of that now when I was observing.

Ms Mokoena : … Like I was saying I think that because of the re-emphasis of the fact that, look, everybody did suffer one way or the other, they sort of got to see that it was everybody’s struggle … . They should now get to understand that that’s why we’re called a Rainbow Nation. Not everybody agreed with apartheid and not everybody suffered. Even all the blacks, not all blacks got to feel what the others felt . So ja [yes], it’s [pause] it’s a difficult topic, ja . But I think if you get the kids to understand why we’re teaching apartheid in the first place and you show the involvement of all races in all the different sides , then I think you have managed to teach it properly. So I think because of my inexperience then — that was my first year of teaching history — so I think I — maybe I over-emphasized the suffering of the blacks versus the whites [emphasis added].

Reprinted with permission from ref. 24 , Sage Publications.

From data to codes

Coding data is a key building block shared across many approaches to data analysis. Coding is a way of organizing and describing data, but is also ultimately a way of transforming data to produce analytic insights. The basic practice of coding involves highlighting a segment of text (this may be a sentence, a clause or a longer excerpt) and assigning a label to it. The aim of the label is to communicate some sort of summary of what is in the highlighted piece of text. Coding is an iterative process, whereby researchers read and reread their transcripts, applying and refining their codes, until they have a coding frame (a set of codes) that is applied coherently across the dataset and that captures and communicates the key features of what is contained in the data as it relates to the researchers’ analytic focus.

What one codes for is entirely contingent on the focus of the research project and the choices the researcher makes about the approach to analysis. At first, one might apply descriptive codes, summarizing what is contained in the interviews. It is rarely desirable to stop at this point, however, because coding is a tool to move from describing the data to interpreting the data. Suppose the researcher is pursuing some version of thematic analysis. In that case, it might be that the objects of coding are aspects of reported action, emotions, opinions, norms, relationships, routines, agreement/disagreement and change over time. A discourse analysis might instead code for different types of speech acts, tropes, linguistic or rhetorical devices. Multiple types of code might be generated within the same research project. What is important is that researchers are aware of the choices they are making in terms of what they are coding for. Moreover, through the process of refinement, the aim is to produce a set of discrete codes — in which codes are conceptually distinct, as opposed to overlapping. By using the same codes across the dataset, the researcher can capture commonalities across the interviews. This process of refinement involves relabelling codes and reorganizing how and where they are applied in the dataset.

From coding to analysis and writing

Data analysis is also an iterative process in which researchers move closer to and further away from the data. As they move away from the data, they synthesize their findings, thus honing and articulating their analytic insights. As they move closer to the data, they ground these insights in what is contained in the interviews. The link should not be broken between the data themselves and higher-order conceptual insights or claims being made. Researchers must be able to show evidence for their claims in the data. Figure  2 summarizes this iterative process and suggests the sorts of activities involved at each stage more concretely.

As well as going through steps 1 to 6 in order, the researcher will also go backwards and forwards between stages. Some stages will themselves be a forwards and backwards processing of coding and refining when working across different interview transcripts.

At the stage of synthesizing, there are some common quandaries. When dealing with a dataset consisting of multiple interviews, there will be salient and minority statements across different participants, or consensus or dissent on topics of interest to the researcher. A strength of qualitative interviews is that we can build in these nuances and variations across our data as opposed to aggregating them away. When exploring and reporting data, researchers should be asking how different findings are patterned and which interviews contain which codes, themes or tropes. Researchers should think about how these variations fit within the longer flow of individual interviews and what these variations tell them about the nature of their substantive research interests.

A further consideration is how to approach analysis within and across interview data. Researchers may look at one individual code, to examine the forms it takes across different participants and what they might be able to summarize about this code in the round. Alternatively, they might look at how a code or set of codes pattern across the account of one participant, to understand the code(s) in a more contextualized way. Further analysis might be done according to different sampling characteristics, where researchers group together interviews based on certain demographic characteristics and explore these together.

When it comes to writing up and presenting interview data, key considerations tend to rest on what is often termed transparency. When presenting the findings of an interview-based study, the reader should be able to understand and trace what the stated findings are based upon. This process typically involves describing the analytic process, how key decisions were made and presenting direct excerpts from the data. It is important to account for how the interview was set up and to consider the active part that the researcher has played in generating the data 32 . Quotes from interviews should not be thought of as merely embellishing or adding interest to a final research output. Rather, quotes serve the important function of connecting the reader directly to the underlying data. Quotes, therefore, should be chosen because they provide the reader with the most apt insight into what is being discussed. It is good practice to report not just on what participants said, but also on the questions that were asked to elicit the responses.

Researchers have increasingly used specialist qualitative data analysis software to organize and analyse their interview data, such as NVivo or ATLAS.ti. It is important to remember that such software is a tool for, rather than an approach or technique of, analysis. That said, software also creates a wide range of possibilities in terms of what can be done with the data. As researchers, we should reflect on how the range of possibilities of a given software package might be shaping our analytical choices and whether these are choices that we do indeed want to make.

Applications

This section reviews how and why in-depth interviews have been used by researchers studying gender, education and inequality, nationalism and ethnicity and the welfare state. Although interviews can be employed as a method of data collection in just about any social science topic, the applications below speak directly to the authors’ expertise and cutting-edge areas of research.

When it comes to the broad study of gender, in-depth interviews have been invaluable in shaping our understanding of how gender functions in everyday life. In a study of the US hedge fund industry (an industry dominated by white men), Tobias Neely was interested in understanding the factors that enable white men to prosper in the industry 33 . The study comprised interviews with 45 hedge fund workers and oversampled women of all races and men of colour to capture a range of experiences and beliefs. Tobias Neely found that practices of hiring, grooming and seeding are key to maintaining white men’s dominance in the industry. In terms of hiring, the interviews clarified that white men in charge typically preferred to hire people like themselves, usually from their extended networks. When women were hired, they were usually hired to less lucrative positions. In terms of grooming, Tobias Neely identifies how older and more senior men in the industry who have power and status will select one or several younger men as their protégés, to include in their own elite networks. Finally, in terms of her concept of seeding, Tobias Neely describes how older men who are hedge fund managers provide the seed money (often in the hundreds of millions of dollars) for a hedge fund to men, often their own sons (but not their daughters). These interviews provided an in-depth look into gendered and racialized mechanisms that allow white men to flourish in this industry.

Research by Rao draws on dozens of interviews with men and women who had lost their jobs, some of the participants’ spouses and follow-up interviews with about half the sample approximately 6 months after the initial interview 34 . Rao used interviews to understand the gendered experience and understanding of unemployment. Through these interviews, she found that the very process of losing their jobs meant different things for men and women. Women often saw job loss as being a personal indictment of their professional capabilities. The women interviewed often referenced how years of devaluation in the workplace coloured their interpretation of their job loss. Men, by contrast, were also saddened by their job loss, but they saw it as part and parcel of a weak economy rather than a personal failing. How these varied interpretations occurred was tied to men’s and women’s very different experiences in the workplace. Further, through her analysis of these interviews, Rao also showed how these gendered interpretations had implications for the kinds of jobs men and women sought to pursue after job loss. Whereas men remained tied to participating in full-time paid work, job loss appeared to be a catalyst pushing some of the women to re-evaluate their ties to the labour force.

In a study of workers in the tech industry, Hart used interviews to explain how individuals respond to unwanted and ambiguously sexual interactions 35 . Here, the researcher used interviews to allow participants to describe how these interactions made them feel and act and the logics of how they interpreted, classified and made sense of them 35 . Through her analysis of these interviews, Hart showed that participants engaged in a process she termed “trajectory guarding”, whereby they sought to monitor unwanted and ambiguously sexual interactions to avoid them from escalating. Yet, as Hart’s analysis proficiently demonstrates, these very strategies — which protect these workers sexually — also undermined their workplace advancement.

Drawing on interviews, these studies have helped us to understand better how gendered mechanisms, gendered interpretations and gendered interactions foster gender inequality when it comes to paid work. Methodologically, these studies illuminate the power of interviews to reveal important aspects of social life.

Nationalism and ethnicity

Traditionally, nationalism has been studied from a top-down perspective, through the lens of the state or using historical methods; in other words, in-depth interviews have not been a common way of collecting data to study nationalism. The methodological turn towards everyday nationalism has encouraged more scholars to go to the field and use interviews (and ethnography) to understand nationalism from the bottom up: how people talk about, give meaning, understand, navigate and contest their relation to nation, national identification and nationalism 36 , 37 , 38 , 39 . This turn has also addressed the gap left by those studying national and ethnic identification via quantitative methods, such as surveys.

Surveys can enumerate how individuals ascribe to categorical forms of identification 40 . However, interviews can question the usefulness of such categories and ask whether these categories are reflected, or resisted, by participants in terms of the meanings they give to identification 41 , 42 . Categories often pitch identification as a mutually exclusive choice; but identification might be more complex than such categories allow. For example, some might hybridize these categories or see themselves as moving between and across categories 43 . Hearing how people talk about themselves and their relation to nations, states and ethnicities, therefore, contributes substantially to the study of nationalism and national and ethnic forms of identification.

One particular approach to studying these topics, whether via everyday nationalism or alternatives, is that of using interviews to capture both articulations and narratives of identification, relations to nationalism and the boundaries people construct. For example, interviews can be used to gather self–other narratives by studying how individuals construct I–we–them boundaries 44 , including how participants talk about themselves, who participants include in their various ‘we’ groupings and which and how participants create ‘them’ groupings of others, inserting boundaries between ‘I/we’ and ‘them’. Overall, interviews hold great potential for listening to participants and understanding the nuances of identification and the construction of boundaries from their point of view.

Education and inequality

Scholars of social stratification have long noted that the school system often reproduces existing social inequalities. Carter explains that all schools have both material and sociocultural resources 45 . When children from different backgrounds attend schools with different material resources, their educational and occupational outcomes are likely to vary. Such material resources are relatively easy to measure. They are operationalized as teacher-to-student ratios, access to computers and textbooks and the physical infrastructure of classrooms and playgrounds.

Drawing on Bourdieusian theory 46 , Carter conceptualizes the sociocultural context as the norms, values and dispositions privileged within a social space 45 . Scholars have drawn on interviews with students and teachers (as well as ethnographic observations) to show how schools confer advantages on students from middle-class families, for example, by rewarding their help-seeking behaviours 47 . Focusing on race, researchers have revealed how schools can remain socioculturally white even as they enrol a racially diverse student population. In such contexts, for example, teachers often misrecognize the aesthetic choices made by students of colour, wrongly inferring that these students’ tastes in clothing and music reflect negative orientations to schooling 48 , 49 , 50 . These assessments can result in disparate forms of discipline and may ultimately shape educators’ assessments of students’ academic potential 51 .

Further, teachers and administrators tend to view the appropriate relationship between home and school in ways that resonate with white middle-class parents 52 . These parents are then able to advocate effectively for their children in ways that non-white parents are not 53 . In-depth interviews are particularly good at tapping into these understandings, revealing the mechanisms that confer privilege on certain groups of students and thereby reproduce inequality.

In addition, interviews can shed light on the unequal experiences that young people have within educational institutions, as the views of dominant groups are affirmed while those from disadvantaged backgrounds are delegitimized. For example, Teeger’s interviews with South African high schoolers showed how — because racially charged incidents are often framed as jokes in the broader school culture — Black students often feel compelled to ignore and keep silent about the racism they experience 54 . Interviews revealed that Black students who objected to these supposed jokes were coded by other students as serious or angry. In trying to avoid such labels, these students found themselves unable to challenge the racism they experienced. Interviews give us insight into these dynamics and help us see how young people understand and interpret the messages transmitted in schools — including those that speak to issues of inequality in their local school contexts as well as in society more broadly 24 , 55 .

The welfare state

In-depth interviews have also proved to be an important method for studying various aspects of the welfare state. By welfare state, we mean the social institutions relating to the economic and social wellbeing of a state’s citizens. Notably, using interviews has been useful to look at how policy design features are experienced and play out on the ground. Interviews have often been paired with large-scale surveys to produce mixed-methods study designs, therefore achieving both breadth and depth of insights.

In-depth interviews provide the opportunity to look behind policy assumptions or how policies are designed from the top down, to examine how these play out in the lives of those affected by the policies and whose experiences might otherwise be obscured or ignored. For example, the Welfare Conditionality project used interviews to critique the assumptions that conditionality (such as, the withdrawal of social security benefits if recipients did not perform or meet certain criteria) improved employment outcomes and instead showed that conditionality was harmful to mental health, living standards and had many other negative consequences 56 . Meanwhile, combining datasets from two small-scale interview studies with recipients allowed Summers and Young to critique assumptions around the simplicity that underpinned the design of Universal Credit in 2020, for example, showing that the apparently simple monthly payment design instead burdened recipients with additional money management decisions and responsibilities 57 .

Similarly, the Welfare at a (Social) Distance project used a mixed-methods approach in a large-scale study that combined national surveys with case studies and in-depth interviews to investigate the experience of claiming social security benefits during the COVID-19 pandemic. The interviews allowed researchers to understand in detail any issues experienced by recipients of benefits, such as delays in the process of claiming, managing on a very tight budget and navigating stigma and claiming 58 .

These applications demonstrate the multi-faceted topics and questions for which interviews can be a relevant method for data collection. These applications highlight not only the relevance of interviews, but also emphasize the key added value of interviews, which might be missed by other methods (surveys, in particular). Interviews can expose and question what is taken for granted and directly engage with communities and participants that might otherwise be ignored, obscured or marginalized.

Reproducibility and data deposition

There is a robust, ongoing debate about reproducibility in qualitative research, including interview studies. In some research paradigms, reproducibility can be a way of interrogating the rigour and robustness of research claims, by seeing whether these hold up when the research process is repeated. Some scholars have suggested that although reproducibility may be challenging, researchers can facilitate it by naming the place where the research was conducted, naming participants, sharing interview and fieldwork transcripts (anonymized and de-identified in cases where researchers are not naming people or places) and employing fact-checkers for accuracy 11 , 59 , 60 .

In addition to the ethical concerns of whether de-anonymization is ever feasible or desirable, it is also important to address whether the replicability of interview studies is meaningful. For example, the flexibility of interviews allows for the unexpected and the unforeseen to be incorporated into the scope of the research 61 . However, this flexibility means that we cannot expect reproducibility in the conventional sense, given that different researchers will elicit different types of data from participants. Sharing interview transcripts with other researchers, for instance, downplays the contextual nature of an interview.

Drawing on Bauer and Gaskell, we propose several measures to enhance rigour in qualitative research: transparency, grounding interpretations and aiming for theoretical transferability and significance 62 .

Researchers should be transparent when describing their methodological choices. Transparency means documenting who was interviewed, where and when (without requiring de-anonymization, for example, by documenting their characteristics), as well as the questions they were asked. It means carefully considering who was left out of the interviews and what that could mean for the researcher’s findings. It also means carefully considering who the researcher is and how their identity shaped the research process (integrating and articulating reflexivity into whatever is written up).

Second, researchers should ground their interpretations in the data. Grounding means presenting the evidence upon which the interpretation relies. Quotes and extracts should be extensive enough to allow the reader to evaluate whether the researcher’s interpretations are grounded in the data. At each step, researchers should carefully compare their own explanations and interpretations with alternative explanations. Doing so systematically and frequently allows researchers to become more confident in their claims. Here, researchers should justify the link between data and analysis by using quotes to justify and demonstrate the analytical point, while making sure the analytical point offers an interpretation of quotes (Box  4 ).

An important step in considering alternative explanations is to seek out disconfirming evidence 4 , 63 . This involves looking for instances where participants deviate from what the majority are saying and thus bring into question the theory (or explanation) that the researcher is developing. Careful analysis of such examples can often demonstrate the salience and meaning of what appears to be the norm (see Table  2 for examples) 54 . Considering alternative explanations and paying attention to disconfirming evidence allows the researcher to refine their own theories in respect of the data.

Finally, researchers should aim for theoretical transferability and significance in their discussions of findings. One way to think about this is to imagine someone who is not interested in the empirical study. Articulating theoretical transferability and significance usually takes the form of broadening out from the specific findings to consider explicitly how the research has refined or altered prior theoretical approaches. This process also means considering under what other conditions, aside from those of the study, the researcher thinks their theoretical revision would be supported by and why. Importantly, it also includes thinking about the limitations of one’s own approach and where the theoretical implications of the study might not hold.

Box 4 An example of grounding interpretations in data (from Rao 34 )

In an article explaining how unemployed men frame their job loss as a pervasive experience, Rao writes the following: “Unemployed men in this study understood unemployment to be an expected aspect of paid work in the contemporary United States. Robert, a white unemployed communications professional, compared the economic landscape after the Great Recession with the tragic events of September 11, 2001:

Part of your post-9/11 world was knowing people that died as a result of terrorism. The same thing is true with the [Great] Recession, right? … After the Recession you know somebody who was unemployed … People that really should be working.

The pervasiveness of unemployment rendered it normal, as Robert indicates.”

Here, the link between the quote presented and the analytical point Rao is making is clear: the analytical point is grounded in a quote and an interpretation of the quote is offered 34 .

Limitations and optimizations

When deciding which research method to use, the key question is whether the method provides a good fit for the research questions posed. In other words, researchers should consider whether interviews will allow them to successfully access the social phenomena necessary to answer their question(s) and whether the interviews will do so more effectively than other methods. Table  3 summarizes the major strengths and limitations of interviews. However, the accompanying text below is organized around some key issues, where relative strengths and weaknesses are presented alongside each other, the aim being that readers should think about how these can be balanced and optimized in relation to their own research.

Breadth versus depth of insight

Achieving an overall breadth of insight, in a statistically representative sense, is not something that is possible or indeed desirable when conducting in-depth interviews. Instead, the strength of conducting interviews lies in their ability to generate various sorts of depth of insight. The experiences or views of participants that can be accessed by conducting interviews help us to understand participants’ subjective realities. The challenge, therefore, is for researchers to be clear about why depth of insight is the focus and what we should aim to glean from these types of insight.

Naturalistic or artificial interviews

Interviews make use of a form of interaction with which people are familiar 64 . By replicating a naturalistic form of interaction as a tool to gather social science data, researchers can capitalize on people’s familiarity and expectations of what happens in a conversation. This familiarity can also be a challenge, as people come to the interview with preconceived ideas about what this conversation might be for or about. People may draw on experiences of other similar conversations when taking part in a research interview (for example, job interviews, therapy sessions, confessional conversations, chats with friends). Researchers should be aware of such potential overlaps and think through their implications both in how the aims and purposes of the research interview are communicated to participants and in how interview data are interpreted.

Further, some argue that a limitation of interviews is that they are an artificial form of data collection. By taking people out of their daily lives and asking them to stand back and pass comment, we are creating a distance that makes it difficult to use such data to say something meaningful about people’s actions, experiences and views. Other approaches, such as ethnography, might be more suitable for tapping into what people actually do, as opposed to what they say they do 65 .

Dynamism and replicability

Interviews following a semi-structured format offer flexibility both to the researcher and the participant. As the conversation develops, the interlocutors can explore the topics raised in much more detail, if desired, or pass over ones that are not relevant. This flexibility allows for the unexpected and the unforeseen to be incorporated into the scope of the research.

However, this flexibility has a related challenge of replicability. Interviews cannot be reproduced because they are contingent upon the interaction between the researcher and the participant in that given moment of interaction. In some research paradigms, replicability can be a way of interrogating the robustness of research claims, by seeing whether they hold when they are repeated. This is not a useful framework to bring to in-depth interviews and instead quality criteria (such as transparency) tend to be employed as criteria of rigour.

Accessing the private and personal

Interviews have been recognized for their strength in accessing private, personal issues, which participants may feel more comfortable talking about in a one-to-one conversation. Furthermore, interviews are likely to take a more personable form with their extended questions and answers, perhaps making a participant feel more at ease when discussing sensitive topics in such a context. There is a similar, but separate, argument made about accessing what are sometimes referred to as vulnerable groups, who may be difficult to make contact with using other research methods.

There is an associated challenge of anonymity. There can be types of in-depth interview that make it particularly challenging to protect the identities of participants, such as interviewing within a small community, or multiple members of the same household. The challenge to ensure anonymity in such contexts is even more important and difficult when the topic of research is of a sensitive nature or participants are vulnerable.

Increasingly, researchers are collaborating in large-scale interview-based studies and integrating interviews into broader mixed-methods designs. At the same time, interviews can be seen as an old-fashioned (and perhaps outdated) mode of data collection. We review these debates and discussions and point to innovations in interview-based studies. These include the shift from face-to-face interviews to the use of online platforms, as well as integrating and adapting interviews towards more inclusive methodologies.

Collaborating and mixing

Qualitative researchers have long worked alone 66 . Increasingly, however, researchers are collaborating with others for reasons such as efficiency, institutional incentives (for example, funding for collaborative research) and a desire to pool expertise (for example, studying similar phenomena in different contexts 67 or via different methods). Collaboration can occur across disciplines and methods, cases and contexts and between industry/business, practitioners and researchers. In many settings and contexts, collaboration has become an imperative 68 .

Cheek notes how collaboration provides both advantages and disadvantages 68 . For example, collaboration can be advantageous, saving time and building on the divergent knowledge, skills and resources of different researchers. Scholars with different theoretical or case-based knowledge (or contacts) can work together to build research that is comparative and/or more than the sum of its parts. But such endeavours also carry with them practical and political challenges in terms of how resources might actually be pooled, shared or accounted for. When undertaking such projects, as Morse notes, it is worth thinking about the nature of the collaboration and being explicit about such a choice, its advantages and its disadvantages 66 .

A further tension, but also a motivation for collaboration, stems from integrating interviews as a method in a mixed-methods project, whether with other qualitative researchers (to combine with, for example, focus groups, document analysis or ethnography) or with quantitative researchers (to combine with, for example, surveys, social media analysis or big data analysis). Cheek and Morse both note the pitfalls of collaboration with quantitative researchers: that quality of research may be sacrificed, qualitative interpretations watered down or not taken seriously, or tensions experienced over the pace and different assumptions that come with different methods and approaches of research 66 , 68 .

At the same time, there can be real benefits of such mixed-methods collaboration, such as reaching different and more diverse audiences or testing assumptions and theories between research components in the same project (for example, testing insights from prior quantitative research via interviews, or vice versa), as long as the skillsets of collaborators are seen as equally beneficial to the project. Cheek provides a set of questions that, as a starting point, can be useful for guiding collaboration, whether mixed methods or otherwise. First, Cheek advises asking all collaborators about their assumptions and understandings concerning collaboration. Second, Cheek recommends discussing what each perspective highlights and focuses on (and conversely ignores or sidelines) 68 .

A different way to engage with the idea of collaboration and mixed methods research is by fostering greater collaboration between researchers in the Global South and Global North, thus reversing trends of researchers from the Global North extracting knowledge from the Global South 69 . Such forms of collaboration also align with interview innovations, discussed below, that seek to transform traditional interview approaches into more participatory and inclusive (as part of participatory methodologies).

Digital innovations and challenges

The ongoing COVID-19 pandemic has centred the question of technology within interview-based fieldwork. Although conducting synchronous oral interviews online — for example, via Zoom, Skype or other such platforms — has been a method used by a small constituency of researchers for many years, it became (and remains) a necessity for many researchers wanting to continue or start interview-based projects while COVID-19 prevents face-to-face data collection.

In the past, online interviews were often framed as an inferior form of data collection for not providing the kinds of (often necessary) insights and forms of immersion face-to-face interviews allow 70 , 71 . Online interviews do tend to be more decontextualized than interviews conducted face-to-face 72 . For example, it is harder to recognize, engage with and respond to non-verbal cues 71 . At the same time, they broaden participation to those who might not have been able to access or travel to sites where interviews would have been conducted otherwise, for example people with disabilities. Online interviews also offer more flexibility in terms of scheduling and time requirements. For example, they provide more flexibility around precarious employment or caring responsibilities without having to travel and be away from home. In addition, online interviews might also reduce discomfort between researchers and participants, compared with face-to-face interviews, enabling more discussion of sensitive material 71 . They can also provide participants with more control, enabling them to turn on and off the microphone and video as they choose, for example, to provide more time to reflect and disconnect if they so wish 72 .

That said, online interviews can also introduce new biases based on access to technology 72 . For example, in the Global South, there are often urban/rural and gender gaps between who has access to mobile phones and who does not, meaning that some population groups might be overlooked unless researchers sample mindfully 71 . There are also important ethical considerations when deciding between online and face-to-face interviews. Online interviews might seem to imply lower ethical risks than face-to-face interviews (for example, they lower the chances of identification of participants or researchers), but they also offer more barriers to building trust between researchers and participants 72 . Interacting only online with participants might not provide the information needed to assess risk, for example, participants’ access to a private space to speak 71 . Just because online interviews might be more likely to be conducted in private spaces does not mean that private spaces are safe, for example, for victims of domestic violence. Finally, online interviews prompt further questions about decolonizing research and engaging with participants if research is conducted from afar 72 , such as how to include participants meaningfully and challenge dominant assumptions while doing so remotely.

A further digital innovation, modulating how researchers conduct interviews and the kinds of data collected and analysed, stems from the use and integration of (new) technology, such as WhatsApp text or voice notes to conduct synchronous or asynchronous oral or written interviews 73 . Such methods can provide more privacy, comfort and control to participants and make recruitment easier, allowing participants to share what they want when they want to, using technology that already forms a part of their daily lives, especially for young people 74 , 75 . Such technology is also emerging in other qualitative methods, such as focus groups, with similar arguments around greater inclusivity versus traditional offline modes. Here, the digital challenge might be higher for researchers than for participants if they are less used to such technology 75 . And while there might be concerns about the richness, depth and quality of written messages as a form of interview data, Gibson reports that the reams of transcripts that resulted from a study using written messaging were dense with meaning to be analysed 75 .

Like with online and face-to-face interviews, it is important also to consider the ethical questions and challenges of using such technology, from gaining consent to ensuring participant safety and attending to their distress, without cues, like crying, that might be more obvious in a face-to-face setting 75 , 76 . Attention to the platform used for such interviews is also important and researchers should be attuned to the local and national context. For example, in China, many platforms are neither legal nor available 76 . There, more popular platforms — like WeChat — can be highly monitored by the government, posing potential risks to participants depending on the topic of the interview. Ultimately, researchers should consider trade-offs between online and offline interview modalities, being attentive to the social context and power dynamics involved.

The next 5–10 years

Continuing to integrate (ethically) this technology will be among the major persisting developments in interview-based research, whether to offer more flexibility to researchers or participants, or to diversify who can participate and on what terms.

Pushing the idea of inclusion even further is the potential for integrating interview-based studies within participatory methods, which are also innovating via integrating technology. There is no hard and fast line between researchers using in-depth interviews and participatory methods; many who employ participatory methods will use interviews at the beginning, middle or end phases of a research project to capture insights, perspectives and reflections from participants 77 , 78 . Participatory methods emphasize the need to resist existing power and knowledge structures. They broaden who has the right and ability to contribute to academic knowledge by including and incorporating participants not only as subjects of data collection, but as crucial voices in research design and data analysis 77 . Participatory methods also seek to facilitate local change and to produce research materials, whether for academic or non-academic audiences, including films and documentaries, in collaboration with participants.

In responding to the challenges of COVID-19, capturing the fraught situation wrought by the pandemic and the momentum to integrate technology, participatory researchers have sought to continue data collection from afar. For example, Marzi has adapted an existing project to co-produce participatory videos, via participants’ smartphones in Medellin, Colombia, alongside regular check-in conversations/meetings/interviews with participants 79 . Integrating participatory methods into interview studies offers a route by which researchers can respond to the challenge of diversifying knowledge, challenging assumptions and power hierarchies and creating more inclusive and collaborative partnerships between participants and researchers in the Global North and South.

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Acknowledgements

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A pre-written interview outline for a semi-structured interview that provides both a topic structure and the ability to adapt flexibly to the content and context of the interview and the interaction between the interviewer and participant. Others may refer to the topic guide as an interview protocol.

Here we refer to the participants that take part in the study as the sample. Other researchers may refer to the participants as a participant group or dataset.

This involves dividing a population into smaller groups based on particular characteristics, for example, age or gender, and then sampling randomly within each group.

A sampling method where the guiding logic when deciding who to recruit is to achieve the most relevant participants for the research topic, in terms of being rich in information or insights.

Researchers ask participants to introduce the researcher to others who meet the study’s inclusion criteria.

Similar to stratified sampling, but participants are not necessarily randomly selected. Instead, the researcher determines how many people from each category of participants should be recruited. Recruitment can happen via snowball or purposive sampling.

A method for developing, analysing and interpreting patterns across data by coding in order to develop themes.

An approach that interrogates the explicit, implicit and taken-for-granted dimensions of language as well as the contexts in which it is articulated to unpack its purposes and effects.

A form of transcription that simplifies what has been said by removing certain verbal and non-verbal details that add no further meaning, such as ‘ums and ahs’ and false starts.

The analytic framework, theoretical approach and often hypotheses, are developed prior to examining the data and then applied to the dataset.

The analytic framework and theoretical approach is developed from analysing the data.

An approach that combines deductive and inductive components to work recursively by going back and forth between data and existing theoretical frameworks (also described as an iterative approach). This approach is increasingly recognized not only as a more realistic but also more desirable third alternative to the more traditional inductive versus deductive binary choice.

A theoretical apparatus that emphasizes the role of cultural processes and capital in (intergenerational) social reproduction.

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How to Effectively Conduct an Expert Interview

Michael Brown, GLG Network Member and President of Strategy

Read Time: 8 Minutes

Read the full e-book: Mastering the Expert Interview.

What is an Expert Interview?  

An expert interview is a qualitative research method to help gather in-depth insights and knowledge from individuals with specialized expertise and authority in a specific field, sector, or topic. Expert interviews play a pivotal role in the overall research process, serving as a dynamic means to gather firsthand insights on a topic/company, validate hypotheses, and refine strategic initiatives.

Benefits of Expert Interviews:    

• Depth of Insight : Expert interviews enable you to delve into complex topics and gain nuanced perspectives that may not be readily available through traditional data sources. Speaking directly to the source also increases the overall credibility of your research.   
• Save Time and Resources : Expert interviews allow you to gather targeting information directly from the source. This focused approach helps reduce the amount of time spent sifting through vast amounts of data from various sources.    
• Customization and Relevance : Unlike standardized reports or syndicated research, expert interviews offer tailored insights that align with the specific objectives and priorities of your research project.  
• Interactive Dialogue : Expert interviews foster an interactive dialogue between researchers and subject matter experts, allowing for real-time clarification, exploration, and synthesis of ideas.  
• Agility and Adaptability : In today’s fast-paced business environment, agility is paramount. Expert interviews provide a flexible and adaptive approach to research, allowing you to pivot quickly in response to evolving market conditions or emerging opportunities.  

Whether it’s financial institutions seeking market insights or corporate firms navigating strategic decisions, expert interviews offer unparalleled advantages.

How to Conduct a Subject Matter Expert Interview

Scottish historian and philosopher Thomas Carlyle once said, “Nothing is more terrible than activity without insight.” When you’re facing a challenging decision, the insights gained by interviewing subject matter experts (SMEs) can help guide you to the best decision before taking action. To make the most of those interviews, it’s best to follow these interviewing best practices so you can maximize the value of your time and effort.

Planning the interview is critical. In fact, it will determine the success of the interview itself and the insights you glean. Planning involves two very important documents. The first is the interview plan, which focuses on selecting the right experts you wish to speak with. The second is the interview guide, which details the very specific questions you intend to discuss with the expert or experts you select.

The Expert Interview Plan

Start with the end in mind and define your goals for doing the research. It is important to know what decision or action you intend to take as a result of your research. From here, you can work backward to determine the intelligence and analysis required to make a well-formed decision. And finally, work backward to outline what raw data and insights are needed to develop that intelligence.

The Expert Interview Plan in Action

Let’s bring this funneling process to life with a fictional example. Imagine that a chemical company wants to understand whether it should enter the market for lubricants in the commercial aircraft engine components business. Before acting, the firm wants to reinforce its decision with intelligence about the opportunity size, the cost and ease of market entry, and the sustainability of profits should it go into that business.

To make a well-informed decision, our imaginary chemical company decides to develop intelligence from data and insights that include primary and secondary sources to answer a set of specific questions. How big is the market? How often are lubricants changed? How much lubricant is used per engine? What lubricants are currently used? Why? How does the value chain work? What are the costs at each step? Is the usage rate likely to change? Are lubricant needs changing? Who are the distinctive suppliers in this area and what differentiates them?

Since much of this data and insight can be developed only with primary sources, our chemical company’s next step is developing an interview plan of the ideal experts who can answer these questions. A first start is to develop keywords that describe unique and specific background characteristics of those experts who have deep industry experience.

In this case, the ideal experts might be OEM project managers , such as those at Pratt & Whitney who specify lubricants and maintenance schedules; airline maintenance managers at carriers such as Delta or America; lubricant formulators at a company such as ExxonMobil Aviation; and managers at base oil suppliers , such as Neste. An expert network like GLG can use these keywords to search and vet the appropriate experts. The final interview plan will not only include the right experts but also sequence the interviews in a logical order that builds your knowledge step by step.

Creating an Expert Interview Guide

As you plan, you should also develop a written interview guide that outlines the questions you intend to ask the SME. Do not think of writing an interview guide as a creative assignment — this can be frustrating and lead to procrastination. Think of it as a mechanical exercise that leads to questions that flow naturally from the intelligence and insight you need to address the decisions you intend to make.

By viewing your project at a macro level and breaking down what you need into the “intelligence themes” seen on the left-hand side, you can translate those into the specific questions in the right-hand column. Many methodologies are available for distilling these questions, including classics such as Porter’s “five forces” analysis and strengths, weaknesses, opportunities, and threats (SWOT).

As you finalize the guide, strike any questions already answered through secondary research and make sure the questions that remain are open-ended so that they won’t be answered by a simple yes or no. It is imperative to prompt as much insight and discussion as possible.

Remain neutral and unbiased when you frame the questions. The goal of the interview process is to get objective input from an expert — not to persuade them that the hypothesis or business idea you have in mind is the correct one and worth pursuing.

It is important that the questions you ask don’t violate third-party secrecy agreements and securities regulations. It is perfectly acceptable to ask an expert about any subject matter, but don’t inadvertently move into an area where the expert is legally bound not to divulge information.

You can discuss market conditions with an employee of a large operating company, but you cannot discuss the current performance of his or her business unit. That information is protected by security regulations and usually an employment contract. As a guide, ask about general trends in the industry, your expert’s views on best practices, and what’s typical in the industry — not specific questions about how the expert’s company handles things.

With thoughtful up-front planning that includes a well-crafted interview plan and interview guide, in-depth interviews with subject matter experts will provide the insight you need to make smart decisions and move your business forward.

Read our companion article, Six Steps to Organizing an Expert Interview .

About the Author

Michael Brown is President of StrategyMark, a Yorklyn, Delaware-based firm providing buy-side analysis and consulting services to the chemical industry. He also serves as an advisor to the board of Inhance Technologies. Earlier, Mr. Brown was a managing partner with TZ Chemicals International Pty. Ltd., the global director of coatings at Quaker Chemical Corp., and a vice president of ChemQuest Group.

Mr. Brown also has extensive expertise advising clients on how they can best engage GLG Network Members. He has been in the GLG network since 2004 and has conducted more than 3,000 consultations with GLG clients, giving him a unique perspective on best practices for getting the most value out of GLG products.

We are the World’s Insight Network, bringing decision makers the insight it takes to get ahead. When leaders need to make informed decisions, GLG provides meaningful connections through our network of experts, the world’s most varied and qualified source of first-hand expertise, with thousands of experts recruited daily to tackle tomorrow’s questions. Learn more about GLG expert calls or fill out the contact form below to speak with the right subject matter expert for your research.

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Chapter 11. Interviewing

Introduction.

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

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

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

Types of Interviews

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

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

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

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

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

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

Creating an Interview Guide

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

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

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

Researcher Note

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

Type of Questions

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

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

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

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

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

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

Background/Demographic Questions

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

Temporality

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

Question Sequence

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

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

Probes and Flexibility

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

The Final Question

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

Conducting the Interview

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

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

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

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

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

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

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

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

How Many Interviews?

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

Your Final Product: The Ideal Interview Transcript

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

Final Tips from an Interview Master

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

Sample: Demographic Questionnaire

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

Supplementary Demographic Questionnaire

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

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

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

What is your current position?

• Grad Student
• Full Professor

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

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

What best reflects your gender?

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

Anything else you would like us to know about you?

Example: Interview Guide

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

Introduction Script/Question

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

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

Further Readings

Britten, Nicky. 1995. “Qualitative Interviews in Medical Research.” BMJ: British Medical Journal 31(6999):251–253. A good basic overview of interviewing particularly useful for students of public health and medical research generally.

Corbin, Juliet, and Janice M. Morse. 2003. “The Unstructured Interactive Interview: Issues of Reciprocity and Risks When Dealing with Sensitive Topics.” Qualitative Inquiry 9(3):335–354. Weighs the potential benefits and harms of conducting interviews on topics that may cause emotional distress. Argues that the researcher’s skills and code of ethics should ensure that the interviewing process provides more of a benefit to both participant and researcher than a harm to the former.

Gerson, Kathleen, and Sarah Damaske. 2020. The Science and Art of Interviewing . New York: Oxford University Press. A useful guidebook/textbook for both undergraduates and graduate students, written by sociologists.

Kvale, Steiner. 2007. Doing Interviews . London: SAGE. An easy-to-follow guide to conducting and analyzing interviews by psychologists.

Lamont, Michèle, and Ann Swidler. 2014. “Methodological Pluralism and the Possibilities and Limits of Interviewing.” Qualitative Sociology 37(2):153–171. Written as a response to various debates surrounding the relative value of interview-based studies and ethnographic studies defending the particular strengths of interviewing. This is a must-read article for anyone seriously engaging in qualitative research!

Pugh, Allison J. 2013. “What Good Are Interviews for Thinking about Culture? Demystifying Interpretive Analysis.” American Journal of Cultural Sociology 1(1):42–68. Another defense of interviewing written against those who champion ethnographic methods as superior, particularly in the area of studying culture. A classic.

Rapley, Timothy John. 2001. “The ‘Artfulness’ of Open-Ended Interviewing: Some considerations in analyzing interviews.” Qualitative Research 1(3):303–323. Argues for the importance of “local context” of data production (the relationship built between interviewer and interviewee, for example) in properly analyzing interview data.

Weiss, Robert S. 1995. Learning from Strangers: The Art and Method of Qualitative Interview Studies . New York: Simon and Schuster. A classic and well-regarded textbook on interviewing. Because Weiss has extensive experience conducting surveys, he contrasts the qualitative interview with the survey questionnaire well; particularly useful for those trained in the latter.

• I say “normally” because how people understand their various identities can itself be an expansive topic of inquiry. Here, I am merely talking about collecting otherwise unexamined demographic data, similar to how we ask people to check boxes on surveys. ↵
• Again, this applies to “semistructured in-depth interviewing.” When conducting standardized questionnaires, you will want to ask each question exactly as written, without deviations! ↵
• I always include “INT” in the number because I sometimes have other kinds of data with their own numbering: FG#001 would mean the first focus group, for example. I also always include three-digit spaces, as this allows for up to 999 interviews (or, more realistically, allows for me to interview up to one hundred persons without having to reset my numbering system). ↵

A method of data collection in which the researcher asks the participant questions; the answers to these questions are often recorded and transcribed verbatim. There are many different kinds of interviews - see also semistructured interview , structured interview , and unstructured interview .

A document listing key questions and question areas for use during an interview.  It is used most often for semi-structured interviews.  A good interview guide may have no more than ten primary questions for two hours of interviewing, but these ten questions will be supplemented by probes and relevant follow-ups throughout the interview.  Most IRBs require the inclusion of the interview guide in applications for review.  See also interview and  semi-structured interview .

A data-collection method that relies on casual, conversational, and informal interviewing.  Despite its apparent conversational nature, the researcher usually has a set of particular questions or question areas in mind but allows the interview to unfold spontaneously.  This is a common data-collection technique among ethnographers.  Compare to the semi-structured or in-depth interview .

A form of interview that follows a standard guide of questions asked, although the order of the questions may change to match the particular needs of each individual interview subject, and probing “follow-up” questions are often added during the course of the interview.  The semi-structured interview is the primary form of interviewing used by qualitative researchers in the social sciences.  It is sometimes referred to as an “in-depth” interview.  See also interview and  interview guide .

The cluster of data-collection tools and techniques that involve observing interactions between people, the behaviors, and practices of individuals (sometimes in contrast to what they say about how they act and behave), and cultures in context.  Observational methods are the key tools employed by ethnographers and Grounded Theory .

Follow-up questions used in a semi-structured interview  to elicit further elaboration.  Suggested prompts can be included in the interview guide  to be used/deployed depending on how the initial question was answered or if the topic of the prompt does not emerge spontaneously.

A form of interview that follows a strict set of questions, asked in a particular order, for all interview subjects.  The questions are also the kind that elicits short answers, and the data is more “informative” than probing.  This is often used in mixed-methods studies, accompanying a survey instrument.  Because there is no room for nuance or the exploration of meaning in structured interviews, qualitative researchers tend to employ semi-structured interviews instead.  See also interview.

The point at which you can conclude data collection because every person you are interviewing, the interaction you are observing, or content you are analyzing merely confirms what you have already noted.  Achieving saturation is often used as the justification for the final sample size.

An interview variant in which a person’s life story is elicited in a narrative form.  Turning points and key themes are established by the researcher and used as data points for further analysis.

Introduction to Qualitative Research Methods Copyright © 2023 by Allison Hurst is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

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Qualitative research method-interviewing and observation

Shazia jamshed.

Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia

Buckley and Chiang define research methodology as “a strategy or architectural design by which the researcher maps out an approach to problem-finding or problem-solving.”[ 1 ] According to Crotty, research methodology is a comprehensive strategy ‘that silhouettes our choice and use of specific methods relating them to the anticipated outcomes,[ 2 ] but the choice of research methodology is based upon the type and features of the research problem.[ 3 ] According to Johnson et al . mixed method research is “a class of research where the researcher mixes or combines quantitative and qualitative research techniques, methods, approaches, theories and or language into a single study.[ 4 ] In order to have diverse opinions and views, qualitative findings need to be supplemented with quantitative results.[ 5 ] Therefore, these research methodologies are considered to be complementary to each other rather than incompatible to each other.[ 6 ]

Qualitative research methodology is considered to be suitable when the researcher or the investigator either investigates new field of study or intends to ascertain and theorize prominent issues.[ 6 , 7 ] There are many qualitative methods which are developed to have an in depth and extensive understanding of the issues by means of their textual interpretation and the most common types are interviewing and observation.[ 7 ]

Interviewing

This is the most common format of data collection in qualitative research. According to Oakley, qualitative interview is a type of framework in which the practices and standards be not only recorded, but also achieved, challenged and as well as reinforced.[ 8 ] As no research interview lacks structure[ 9 ] most of the qualitative research interviews are either semi-structured, lightly structured or in-depth.[ 9 ] Unstructured interviews are generally suggested in conducting long-term field work and allow respondents to let them express in their own ways and pace, with minimal hold on respondents’ responses.[ 10 ]

Pioneers of ethnography developed the use of unstructured interviews with local key informants that is., by collecting the data through observation and record field notes as well as to involve themselves with study participants. To be precise, unstructured interview resembles a conversation more than an interview and is always thought to be a “controlled conversation,” which is skewed towards the interests of the interviewer.[ 11 ] Non-directive interviews, form of unstructured interviews are aimed to gather in-depth information and usually do not have pre-planned set of questions.[ 11 ] Another type of the unstructured interview is the focused interview in which the interviewer is well aware of the respondent and in times of deviating away from the main issue the interviewer generally refocuses the respondent towards key subject.[ 11 ] Another type of the unstructured interview is an informal, conversational interview, based on unplanned set of questions that are generated instantaneously during the interview.[ 11 ]

In contrast, semi-structured interviews are those in-depth interviews where the respondents have to answer preset open-ended questions and thus are widely employed by different healthcare professionals in their research. Semi-structured, in-depth interviews are utilized extensively as interviewing format possibly with an individual or sometimes even with a group.[ 6 ] These types of interviews are conducted once only, with an individual or with a group and generally cover the duration of 30 min to more than an hour.[ 12 ] Semi-structured interviews are based on semi-structured interview guide, which is a schematic presentation of questions or topics and need to be explored by the interviewer.[ 12 ] To achieve optimum use of interview time, interview guides serve the useful purpose of exploring many respondents more systematically and comprehensively as well as to keep the interview focused on the desired line of action.[ 12 ] The questions in the interview guide comprise of the core question and many associated questions related to the central question, which in turn, improve further through pilot testing of the interview guide.[ 7 ] In order to have the interview data captured more effectively, recording of the interviews is considered an appropriate choice but sometimes a matter of controversy among the researcher and the respondent. Hand written notes during the interview are relatively unreliable, and the researcher might miss some key points. The recording of the interview makes it easier for the researcher to focus on the interview content and the verbal prompts and thus enables the transcriptionist to generate “verbatim transcript” of the interview.

Similarly, in focus groups, invited groups of people are interviewed in a discussion setting in the presence of the session moderator and generally these discussions last for 90 min.[ 7 ] Like every research technique having its own merits and demerits, group discussions have some intrinsic worth of expressing the opinions openly by the participants. On the contrary in these types of discussion settings, limited issues can be focused, and this may lead to the generation of fewer initiatives and suggestions about research topic.

Observation

Observation is a type of qualitative research method which not only included participant's observation, but also covered ethnography and research work in the field. In the observational research design, multiple study sites are involved. Observational data can be integrated as auxiliary or confirmatory research.[ 11 ]

Research can be visualized and perceived as painstaking methodical efforts to examine, investigate as well as restructure the realities, theories and applications. Research methods reflect the approach to tackling the research problem. Depending upon the need, research method could be either an amalgam of both qualitative and quantitative or qualitative or quantitative independently. By adopting qualitative methodology, a prospective researcher is going to fine-tune the pre-conceived notions as well as extrapolate the thought process, analyzing and estimating the issues from an in-depth perspective. This could be carried out by one-to-one interviews or as issue-directed discussions. Observational methods are, sometimes, supplemental means for corroborating research findings.

Qualitative Research 101: Interviewing

5 Common Mistakes To Avoid When Undertaking Interviews

By: David Phair (PhD) and Kerryn Warren (PhD) | March 2022

Undertaking interviews is potentially the most important step in the qualitative research process. If you don’t collect useful, useable data in your interviews, you’ll struggle through the rest of your dissertation or thesis.  Having helped numerous students with their research over the years, we’ve noticed some common interviewing mistakes that first-time researchers make. In this post, we’ll discuss five costly interview-related mistakes and outline useful strategies to avoid making these.

Overview: 5 Interviewing Mistakes

• Not having a clear interview strategy /plan
• Not having good interview techniques /skills
• Not securing a suitable location and equipment
• Not having a basic risk management plan
• Not keeping your “ golden thread ” front of mind

1. Not having a clear interview strategy

The first common mistake that we’ll look at is that of starting the interviewing process without having first come up with a clear interview strategy or plan of action. While it’s natural to be keen to get started engaging with your interviewees, a lack of planning can result in a mess of data and inconsistency between interviews.

There are several design choices to decide on and plan for before you start interviewing anyone. Some of the most important questions you need to ask yourself before conducting interviews include:

• What are the guiding research aims and research questions of my study?
• Will I use a structured, semi-structured or unstructured interview approach?
• How will I record the interviews (audio or video)?
• Who will be interviewed and by whom ?
• What ethics and data law considerations do I need to adhere to?
• How will I analyze my data? 

Let’s take a quick look at some of these.

The core objective of the interviewing process is to generate useful data that will help you address your overall research aims. Therefore, your interviews need to be conducted in a way that directly links to your research aims, objectives and research questions (i.e. your “golden thread”). This means that you need to carefully consider the questions you’ll ask to ensure that they align with and feed into your golden thread. If any question doesn’t align with this, you may want to consider scrapping it.

Another important design choice is whether you’ll use an unstructured, semi-structured or structured interview approach . For semi-structured interviews, you will have a list of questions that you plan to ask and these questions will be open-ended in nature. You’ll also allow the discussion to digress from the core question set if something interesting comes up. This means that the type of information generated might differ a fair amount between interviews.

Contrasted to this, a structured approach to interviews is more rigid, where a specific set of closed questions is developed and asked for each interviewee in exactly the same order. Closed questions have a limited set of answers, that are often single-word answers. Therefore, you need to think about what you’re trying to achieve with your research project (i.e. your research aims) and decided on which approach would be best suited in your case.

It is also important to plan ahead with regards to who will be interviewed and how. You need to think about how you will approach the possible interviewees to get their cooperation, who will conduct the interviews, when to conduct the interviews and how to record the interviews. For each of these decisions, it’s also essential to make sure that all ethical considerations and data protection laws are taken into account.

Finally, you should think through how you plan to analyze the data (i.e., your qualitative analysis method) generated by the interviews. Different types of analysis rely on different types of data, so you need to ensure you’re asking the right types of questions and correctly guiding your respondents.

Simply put, you need to have a plan of action regarding the specifics of your interview approach before you start collecting data. If not, you’ll end up drifting in your approach from interview to interview, which will result in inconsistent, unusable data.

2. Not having good interview technique

While you’re generally not expected to become you to be an expert interviewer for a dissertation or thesis, it is important to practice good interview technique and develop basic interviewing skills .

Let’s go through some basics that will help the process along.

Firstly, before the interview , make sure you know your interview questions well and have a clear idea of what you want from the interview. Naturally, the specificity of your questions will depend on whether you’re taking a structured, semi-structured or unstructured approach, but you still need a consistent starting point . Ideally, you should develop an interview guide beforehand (more on this later) that details your core question and links these to the research aims, objectives and research questions.

Before you undertake any interviews, it’s a good idea to do a few mock interviews with friends or family members. This will help you get comfortable with the interviewer role, prepare for potentially unexpected answers and give you a good idea of how long the interview will take to conduct. In the interviewing process, you’re likely to encounter two kinds of challenging interviewees ; the two-word respondent and the respondent who meanders and babbles. Therefore, you should prepare yourself for both and come up with a plan to respond to each in a way that will allow the interview to continue productively.

To begin the formal interview , provide the person you are interviewing with an overview of your research. This will help to calm their nerves (and yours) and contextualize the interaction. Ultimately, you want the interviewee to feel comfortable and be willing to be open and honest with you, so it’s useful to start in a more casual, relaxed fashion and allow them to ask any questions they may have. From there, you can ease them into the rest of the questions.

As the interview progresses , avoid asking leading questions (i.e., questions that assume something about the interviewee or their response). Make sure that you speak clearly and slowly , using plain language and being ready to paraphrase questions if the person you are interviewing misunderstands. Be particularly careful with interviewing English second language speakers to ensure that you’re both on the same page.

Engage with the interviewee by listening to them carefully and acknowledging that you are listening to them by smiling or nodding. Show them that you’re interested in what they’re saying and thank them for their openness as appropriate. This will also encourage your interviewee to respond openly.

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3. Not securing a suitable location and quality equipment

Where you conduct your interviews and the equipment you use to record them both play an important role in how the process unfolds. Therefore, you need to think carefully about each of these variables before you start interviewing.

Poor location: A bad location can result in the quality of your interviews being compromised, interrupted, or cancelled. If you are conducting physical interviews, you’ll need a location that is quiet, safe, and welcoming . It’s very important that your location of choice is not prone to interruptions (the workplace office is generally problematic, for example) and has suitable facilities (such as water, a bathroom, and snacks).

If you are conducting online interviews , you need to consider a few other factors. Importantly, you need to make sure that both you and your respondent have access to a good, stable internet connection and electricity. Always check before the time that both of you know how to use the relevant software and it’s accessible (sometimes meeting platforms are blocked by workplace policies or firewalls). It’s also good to have alternatives in place (such as WhatsApp, Zoom, or Teams) to cater for these types of issues.

Poor equipment: Using poor-quality recording equipment or using equipment incorrectly means that you will have trouble transcribing, coding, and analyzing your interviews. This can be a major issue , as some of your interview data may go completely to waste if not recorded well. So, make sure that you use good-quality recording equipment and that you know how to use it correctly.

To avoid issues, you should always conduct test recordings before every interview to ensure that you can use the relevant equipment properly. It’s also a good idea to spot check each recording afterwards, just to make sure it was recorded as planned. If your equipment uses batteries, be sure to always carry a spare set.

4. Not having a basic risk management plan

Many possible issues can arise during the interview process. Not planning for these issues can mean that you are left with compromised data that might not be useful to you. Therefore, it’s important to map out some sort of risk management plan ahead of time, considering the potential risks, how you’ll minimize their probability and how you’ll manage them if they materialize.

Common potential issues related to the actual interview include cancellations (people pulling out), delays (such as getting stuck in traffic), language and accent differences (especially in the case of poor internet connections), issues with internet connections and power supply. Other issues can also occur in the interview itself. For example, the interviewee could drift off-topic, or you might encounter an interviewee who does not say much at all.

You can prepare for these potential issues by considering possible worst-case scenarios and preparing a response for each scenario. For instance, it is important to plan a backup date just in case your interviewee cannot make it to the first meeting you scheduled with them. It’s also a good idea to factor in a 30-minute gap between your interviews for the instances where someone might be late, or an interview runs overtime for other reasons. Make sure that you also plan backup questions that could be used to bring a respondent back on topic if they start rambling, or questions to encourage those who are saying too little.

In general, it’s best practice to plan to conduct more interviews than you think you need (this is called oversampling ). Doing so will allow you some room for error if there are interviews that don’t go as planned, or if some interviewees withdraw. If you need 10 interviews, it is a good idea to plan for 15. Likely, a few will cancel , delay, or not produce useful data.

5. Not keeping your golden thread front of mind

We touched on this a little earlier, but it is a key point that should be central to your entire research process. You don’t want to end up with pages and pages of data after conducting your interviews and realize that it is not useful to your research aims . Your research aims, objectives and research questions – i.e., your golden thread – should influence every design decision and should guide the interview process at all times. 

A useful way to avoid this mistake is by developing an interview guide before you begin interviewing your respondents. An interview guide is a document that contains all of your questions with notes on how each of the interview questions is linked to the research question(s) of your study. You can also include your research aims and objectives here for a more comprehensive linkage. 

You can easily create an interview guide by drawing up a table with one column containing your core interview questions . Then add another column with your research questions , another with expectations that you may have in light of the relevant literature and another with backup or follow-up questions . As mentioned, you can also bring in your research aims and objectives to help you connect them all together. If you’d like, you can download a copy of our free interview guide here .

Recap: Qualitative Interview Mistakes

In this post, we’ve discussed 5 common costly mistakes that are easy to make in the process of planning and conducting qualitative interviews.

To recap, these include:

If you have any questions about these interviewing mistakes, drop a comment below. Alternatively, if you’re interested in getting 1-on-1 help with your thesis or dissertation , check out our dissertation coaching service or book a free initial consultation with one of our friendly Grad Coaches.

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The expert interview as a method of qualitative social research

Term paper, 2007, 31 pages, grade: 2,0, stefanie monke (author), table of contents, 1 introduction, 2 the expert interview.

3 Scientific and methodological foundations 3.1 Strategy and approach of empirical social research 3.2 Methodological classification of the expert interviews

4 The circle of experts for the expert interview 4.1 The expert and the expert knowledge according to Meuser and Nagel 4.1.1 Experts with operational knowledge 4.1.2 Experts with contextual knowledge 4.1.3 Experts in exploration 4.2 The expert term according to Bogner and Menz 4.2.1 The voluntarist expert concept 4.2.2 The constructivist concept of experts 4.2.3 The sociological concept of experts in the sociology of knowledge 4.3 The expert after glasses and laudel 4.3.1 The expert as a privileged person in a functional context 4.3.2 The expert as a person with special knowledge of social issues 4.4 The application of the expert interview and selection of experts 4.5 Application forms of the expert interview

5 The guideline-based expert interview as Survey method 5.1 From research question to interview guide 5.2 From the research question to select the experts 5.3 The guiding questions and guideline construction 5.4 Typing of interview questions 5.5 Guide function 5.6 Practical information on guideline construction 5.7 Data collection considerations 5.7.1 Scheduling 5.7.2 Case group selection and case size 5.8 Conducting the expert interview and the role income of the interviewers 5.9 The interview situation as a potential problem area 5.10 Notes on data evaluation

6 The expert interview in health and nursing research 6.1 Application examples of health and nursing research 6.2 Frequency of application and methodological reflection

7 Criticism of the method of expert interview 7.1 Criticism of the concept of experts and expertsknow 7.2 Other interview procedures with experts

9 Bibliography

The expert interview is a frequently used method in empirical social research. It is used in policy and implementation research, in industrial sociology, in elite and usage research, and in many areas of applied social research. The main interest in the interview is the expert knowledge, the expertise of a person (cf. Bohnsack et al. 2003, p. 57).

Against the background of the increasing spread of expert interviews in nursing science, this form of interview is presented as a method of qualitative social research in the first part of the present term paper.

Another chapter deals with the question of who can be drawn into the circle of experts for this form of interview. The following chapters contain the concrete application of the expert interview as well as the evaluation of the data.

At the end of the work, an excursus presents the expert interview in health and nursing research. A critical methodological discussion about the expert interview forms the conclusion of the present term paper.

The expert interview is one of the most frequently used methods in empirical social research. It provides exclusive insights into expert knowledge and into structural contexts as well as change processes of action systems. The aim of the expert interview is to discover the unknown, a person's "insider knowledge" (Liebhold et al. 2005). The expert interview serves to conduct good interviews quickly and easily. This method meets with broad approval among experts (cf. Bogner et al. 2005 a, p. 7 f.).

Lamnek describes the expert interview as an investigating and informative form of interview in order to learn about knowledge. The respondent is regarded as a source of information for facts (cf. Lamnek 2005, p. 333 f.).

Expert interviews are not simple "information talks" in which knowledge and opinions are collected (cf. Bogner et al. 2005 a, p. 16). Since the experts are often not aware of the relevance of their actions, expert knowledge cannot be queried directly, but must be reconstructed from the statements of the experts. That's why the expert interview is considered a reconstructive method of investigation. The aim is the systematic reconstruction of the unconscious logic of decisions and routines in expert action (cf. Bohnsack et al. 2003, p. 58 and Gläser et al. 2004, p.11).

According to Bortz, the expert interview is classified as a variant of the qualitative individual survey. It is regarded as a collective term for open or partially assessed surveys of experts on a given area or topic (cf. Bortz 2006, p. 315).

For a long time, a standardized survey was regarded as the "royal road of practical social research", but attention to other qualitative forms of interview was low. In 1967, Scheuch reported on a form of interview that was not standardized and could be evaluated quantitatively. He calls this a kind of "special form of questioning", the so-called expert interview. He lists the advantage of this interview method because the researcher is part of the interaction in the interview and can thus design it flexibly.

Scheuch recommends using an interview guide for the conduct of this "special form of questioning" in order to deepen pre-scientific knowledge (cf. Bogner 2005 a, p. 17 f.).

In 1974, Koolwijk also understood the expert interview as a non-standardized interview method with the task of being an "investigating and informative interview", comparable to a journalistic interview that is close to everyday communication. In this way, expert interviews remain a preliminary stage to the actual research project, an instrument of exploration and not of theory generation. Therefore, the expert interview has remained a rather "marginal procedure" in the social science for many years. Only the insight into the special qualities of qualitative research since the 70s in Germany and their consolidation in the 80s, the question of the usefulness of expert interviews is no longer asked. Discussions about the expert interview today revolve around the question of inclusion and exclusion criteria and who may belong to the circle of experts surveyed. The starting point and reference point of the current discussion about the expert interview is the article by Meuser and Nagel from 1991 with the title: "Expert interviews - tried and tested, little considered". In addition, there are few other attempts to systematically justify the method of the expert interview (cf. Bogner 2005 a, pp. 17 – 20).

The expert interview is characterized by three main features:

- Respondents must be experts in a specific subject area - the focus is on the knowledge of the respondent, there is less interest in the person and their biography - a high degree of pragmatism in interviewing by means of guidelines and selective data evaluation (cf. Flick 2002, p. 206)

The evaluation of the expert interviews is intended to highlight the joint knowledge of the experts on a specific topic and to integrate them into theoretical discourses. It takes place in six steps:

1.Topic-oriented transcription 2. Paraphrasing 3. Thematic overview 4. thematic comparison between the interviews 5. Conceptualization and conceptualization 6. Integration into theoretical discourses (cf. Bohnsack et al. 2003, p. 58)

3 Scientific and methodological foundations

According to Meuser and Nagel, the expert interview belongs to the genuinely qualitative paradigm. However, there are contrary positions in the social sciences that describe the expert interview as belonging to quantitative social research. Today, however, the focus is less on the relevance of the disputes between the knowledge theorists, and much more on the recognition of the expert interview as an independent survey method in qualitative social research. This is by no means universally accepted in the scientific community (cf. Bogner et al. 2005 b, p. 34 f. u. Bogner et al. 2005 a, p. 19). In the following, the methodological positioning of the expert interview as an independent method is explained.

Empirical social research is divided into quantitative and qualitative social research. Behind both branches of research is a certain sociological tradition and scientific-theoretical way of thinking. The scientific-theoretical paradigm of quantitative social research is a normative paradigm, looking for objective reality. The scientific-theoretical paradigm of qualitative social research is an interpretative one.

Social reality is understood as one constructed by interpretations. All interactions between actors are here an interpretative process and not objectively predetermined (cf. Lamnek 2005, p. 34 et s.). What the adherents of both paradigms have in common is that they want to interpret social action. They use different procedures, different examination methods and different evaluation methods.

3.1 Strategy and approach of empirical social research

The strategy of quantitative social research is called a statistics-based explanatory strategy and is based on significant statistical causal relationships. It thus follows the normative paradigm. The quantitative methods describe social issues in numbers, characteristics and map them in scales. The statistics-based explanation strategy requires a large number of cases and quantifying survey methods as well as statistical evaluation methods.

The strategy of qualitative social research is to discover the causal mechanisms in social processes by investigating one or fewer cases as completely as possible. The qualitative methods follow the case-based strategy. They interpret and describe social issues and try to fully elucidate them in terms of the interpretive paradigm. The data material of qualitative survey methods from interview logs or observation protocols is initially fuzzy. Through further systematic evaluation methods such as the qualitative content analysis according to Mayring, information is extracted and processed separately from the text material.

Each scientific discipline develops its own methodology in order to achieve research success with the right choice and implementation of its methods and to obtain answers to its questions (cf. Gläser et al. 2004, pp. 21 - 30 and pp. 41 - 44).

3.2 Methodological classification of the expert interviews

The choice of a research instrument and the choice of a method for data analysis allow conclusions to be drawn about the underlying scientific paradigm. The expert interview as a reconstruction of social issues is committed to the case-based explanatory strategy and thus to the qualitative social research paradigm. A few cases are fully investigated. However, the complete degree of openness and neutrality of the interviewer according to the usual principles of qualitative social research is limited by the use of the interview guide for research-pragmatic reasons. For reasons, see the explanations in the chapter on the interview.

The expert interview can be used as an independent qualitative method in investigations. The experts are named according to the question. They open up access to insider knowledge, the unknown and implicit rules. Giving interviews with experts "... exclusive insights into structural contexts and change processes of action systems, for example into decision-making structures and problem solving of organizations and institutions. ... Expert interviews thus enable a privileged view of the problem." (Liebhold et al. 2005). If the expert interview is used to collect diagnostic and prognostic operational knowledge - the knowledge of maxims and implementation - it serves as the primary method of data gain (cf. Meuser et al. 2005 b, p. 266 f.).

The expert interview can be conducted both as an independent qualitative research method and as part of a triangulation, e.g. with the help of document analysis and observation of the research field (cf. Bohnsack et al. 2003, p. 57 u. Gläser et al. 2004, p. 102 f.). If especially the contextual knowledge of the experts is of interest with regard to certain problem situations or the expert interview is used exploratively-field-closing, it becomes an additional secondary method with a marginal position (cf. Meuser et al. 2005 b, pp. 265 - 267 u. Meuser et al. 2005 a, p. 75).

For the final analysis and evaluation of expert interviews, the qualitative content analysis according to Mayring is suitable according to Gläser and Laudel. Descriptions of social issues are systematically taken from the interview transcripts (cf. Gläser et al. 2004, p. 43 f.).

In social reporting, the evaluation strategy of Anselm Strauss is also used, in which thematically related interview passages are theoretically generalized (cf. Meuser et al. 2005 b, p. 269 f.).

4 The circle of experts for the expert interview

On the question of who now has expertise and is invited to the expert interviews, there are different views among the authors of social science. The discussion on this is being conducted at various levels. In the discussion of social and modernization theory, the expertocratization of society, the so-called expert rule over the community, is called for with the consequence of the incapacitation by these experts and elites.

In the sociological discussion of knowledge, Schütz distinguishes the expert from the man on the street and the well-informed citizen. According to Schütz, expert knowledge is clearly and distinctly available in his field, his views are based on certain assertions. Sprondel sees the expert and his expertise strongly tied to a professional role, because not every everyday knowledge of a layman is already a special knowledge and thus expert knowledge. Hitzler links expert knowledge not only to a professional role, but also to an autonomy of action. According to Hitzler, special lists are people who solve technical problems. Experts, on the other hand, have a wide range of skills, extensive and privileged knowledge of the system and are subject to little control. Meuser and Nagel recommend the development of the concept of expert along the professional role (cf. Meuser et al. 2005 b, pp. 258 – 262).

Methodologically, the discussion about experts is conducted in the focus of the respective research interest and object of investigation. In the interviews, experts act as privileged persons of the functional elite or as persons with a special knowledge advantage on social issues. Here, the expert knowledge is seen outside the professional context and the interview group also includes volunteers in social work, activists from aid organizations and citizens' initiatives. They, too, have privileged access to institutionalised knowledge. A pretest should make it clear who is able to answer the research questions exclusively (cf. Meuser et al. 2005 b, p. 262 f.).

4.1 The expert and the expert knowledge according to Meuser and Nagel

The expert is of interest as a functionary and not as a private person with his biographical history. Experts are representatives of implicit knowledge, typical problem theories, solutions and decision-making models. They do not act as experts from outside, but are themselves part of the field of action and have privileged access to information. Their knowledge, which they have acquired in an institutional context, is generated in the expert interview for a specific problem perspective.

The knowledge of the experts can be divided into operational knowledge and contextual knowledge. Both contain statements about the diagnosis and prognosis of a research object. This knowledge is not always found among experts at the top functional level of an organization, but rather at the second and third levels. Here the knowledge about structures and events is available in detail and decisions are prepared and enforced (cf. Meuser et al. 2005 a, p. 73 f. u. Meuser et al. 2005 b, p. 264 f.).

4.1.1 Experts with operational knowledge

Experts with operational knowledge are responsible and implement innovations. They form the top management of politics, business, science, justice and associations (cf. Meuser et al. 2005 a, p. 73).

In expert interviews, the structural conditions of implementations of programs are reconstructed. They cannot simply be queried, because action and structural contexts are often not clear and clear to the experts (cf. Meuser et al. 2005 b, p. 264 f. and p. 267 f.).

These experts with operational knowledge form the target group for studies of industrial sociological research, elite, implementation and professionalization research (cf. Meuser 2005 a, p. 75).

4.1.2 Experts with contextual knowledge

The contextual knowledge of experts is mainly used when it comes to problem structuring, e.g. living conditions of certain populations. This is primarily about the evaluation and assessment of certain contexts and not about the exploration of the expert's actions (cf. Meuser et al. 2005 b, p. 265). Expert interviews take place here as part of research into affected persons, social problems and inequalities. The expert interviews are a secondary source of data here, along with other methods of investigation (cf. Meuser et al. 2005 a, p. 75).

4.1.3 Experts in exploration

For the exploration of a field of investigation, the expert interview is a first important step in establishing a research design on the basis of expert knowledge (cf. Meuser et al. 2005 b, p. 266).

4.2 The expert term according to Bogner and Menz

Bogner and Menz define the concept of experts from a voluntarist, constructivist and sociological perspective.

4.2.1 The voluntarist expert concept

According to this, all people are experts in their own lives. It is about the everyday knowledge and skills for coping with everyday life. According to the voluntarist understanding, these can also be laymen. Meuser and Nagel criticize this lack of differentiation between laymen and experts. Laymen are not included in the circle of interviewees for the method of expert interview. In everyday knowledge, the overall person is of interest and therefore other methods, such as the narrative interview or problem-centered interview, are suitable. Authors such as Gläser and Laudel, as mentioned below, take a different position on this (cf. Bogner et al 2005 b, p. 39 f.).

4.2.2 The constructivist concept of experts

The role of "being an expert" is based on the attribution of expertise by the researcher. It determines the selection and the expert becomes a construct of research interest. With the mechanism of attribution of the expert role, a methodical-relational approach and a social-representational approach are pursued. The methodical-relational approach is interested in objective factual knowledge and is not only looking for experts in the top hierarchical levels of an organization. In the social-representational approach of the concept of expert, on the other hand, the particularly representative personalities and members of functional elites are meant, who are equipped with influential specialist knowledge and prestige (cf. Bogner et al. 2005 b, p. 40 f.).

4.2.3 The sociological concept of experts in the sociology of knowledge

The knowledge-sociological expert has become very important for the method of theory-generating expert interviews. The experts are scientists and have a high degree of specialist and specialist knowledge. Schütz characterizes this knowledge as special knowledge, which is related to the exercise of a profession, in contrast to general knowledge (cf. Bogner et al 2005 b, p. 41 f.).

4.3 The expert after glasses and laudel

Gläser and Laudel describe experts either as a privileged person in a functional context or as a person who has special knowledge of social issues.

4.3.1 The expert as a privileged person in a functional context

The determination of the expert is made according to Gläser and Laudel in his professionally bound special knowledge and special knowledge, in his expertise. Historically, the development of expertise is closely linked to a differentiation and professionalization of professional roles. The expert differs from the layman, who has only a general knowledge, by his socially institutionalized expertise.

"As an expert, we interview those who are characterized by an "institutionalized competence for the construction of reality"." and it "... aims at the knowledge advantage resulting from the privileged position of the expert in a functional context." (Bohnsack et al. 2003, p.57).

Experts with a special, sometimes even exclusive position within social contexts are interviewed. It can be politicians who have information about political decision-making processes or employees in companies who have information about the structure and internal processes of the company (cf. Gläser et al. 2004, p. 10).

The application of the expert interview is therefore based on a narrow expert concept.

Persons who have developed into "experts for their own lives" in their biography are excluded as interview partners. This is intended to ensure a clear separation between biography research and the method of expert interviews (cf. Bohnsack et al. 2003, p. 57).

Biography work as a reconstructive method of investigation serves self-representation, i.e. the question of how a person lives with his past and what effects it has. Social processes and circumstances may remain completely irrelevant in the representation of the situation. Biography work does not ask how it really was, but how the person perceived his life circumstances (cf. Gläser et al. 2004, p. 11).

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• Research Note
• Open access
• Published: 15 May 2024

Concepts of lines of therapy in cancer treatment: findings from an expert interview-based study

• Lisa Falchetto 1   na1 ,
• Bernd Bender 1 , 2   na1 ,
• Ian Erhard 1 , 2 ,
• Kim N. Zeiner 3 ,
• Jan A. Stratmann 11 ,
• Florestan J. Koll 4 ,
• Sebastian Wagner 11 ,
• Marcel Reiser 5 ,
• Khayal Gasimli 6 ,
• Angelika Stehle 7 ,
• Martin Voss 8 ,
• Olivier Ballo 11 ,
• Jörg Janne Vehreschild 1 , 9 , 10 &
• Daniel Maier 1 , 2  

BMC Research Notes volume  17 , Article number:  137 ( 2024 ) Cite this article

Metrics details

The concept of lines of therapy (LOT) in cancer treatment is often considered for decision making in tumor boards and clinical management, but lacks a common definition across medical specialties. The complexity and heterogeneity of malignancies and treatment modalities contribute to an inconsistent understanding of LOT among physicians. This study assesses the heterogeneity of understandings of the LOT concept, its major dimensions, and criteria from the perspective of physicians of different specialties with an oncological focus in Germany. Semi-structured expert interviews with nine physicians were conducted and evaluated using qualitative content analysis.

Most interviewees agreed that there is no single definition for LOT and found it difficult to explicate their understanding. A majority of experts stated that they had already encountered misunderstandings with colleagues regarding LOT and that they had problems with deciphering LOT from the medical records of their patients. Disagreement emerged about the roles of the following within the LOT concept: maintenance therapy, treatment intention, different therapy modalities, changing pharmaceutical agents, and therapy breaks. Respondents predominantly considered the same criteria as decisive for the definition of LOT as for a change in LOT (e.g., the occurrence of a progression event or tumor recurrence).

Peer Review reports

Introduction

While clinical oncology considers line of therapy (LOT) essential information for therapy planning, the field lacks a homogeneous understanding of the concept, as well as clear and consistent criteria for its classification [ 1 ]. Especially in real-world data-based research, it is often unclear whether a certain therapy is still part of an LOT; and often, conflicting interpretations lead to misunderstandings in information exchange about therapy progression [ 1 ]. Existing approaches, for standardizing the classification of LOT either focus on patterns proposed by guidelines (e.g., drug administration period, first-line termination) or on drug administration sequences [ 2 , 3 , 4 , 5 , 6 ]. However, other issues related to the LOT concept remain largely unclear. For example, the roles of maintenance therapies and local therapy modalities have not yet been discussed [ 1 ].

This expert-interview study aims to provide a better conceptual understanding of the defining criteria of LOT for solid and non-solid cancers. Therefore, it may contribute to identifying unclear aspects of the LOT concept and avoiding misunderstandings in communication about LOTs, especially between physicians of different medical disciplines. Concerning the rapidly developing field of real-world cancer research, data augmentation strategies and feature engineering require empirically validated concepts to obtain reliable evidence from observational data. More specifically, investigating the conceptual understanding of LOTs will help us build a rule-based framework for LOT classification within the Clinical Communication Platform of the German Cancer Consortium (DKTK).

The study’s target group was physicians from various specialties with an oncological focus, working in either university hospitals or private practice. Physicians from the University Hospital Frankfurt and private practices were contacted by e-mail. In total, nine were interviewed. Their varied specialties included neuro-oncology, pulmonology, hematology and medical oncology, urology, dermatology, and gynecological oncology, as well as one resident specialist in internal medicine with a focus on hematology and oncology. The interviewees’ professional experience ranged from 3.5 to 29 years and most had experience in treating both solid and non-solid malignancies.

Qualitative expert interviews [ 7 , 8 ] were conducted by posing open questions within a semi-structured framework [ 9 ]. An interview manual delineated this framework and was developed based on existing literature about oncological LOTs and associated concepts (see Additional File 1 ). Before the interviews, the interview manual was pre-tested with an experienced oncologist and adjusted accordingly. Each participant declared their consent before the interview. Confidentiality and anonymity of participants’ responses and information were assured. The first part of the interview manual asked about the interviewee’s underlying understanding of LOTs and the relevant criteria for their definition. Subsequently, questions concerning misunderstandings in interactions with colleagues were posed to determine whether there are frequent uncertainties in the use of the LOT concept and, if so, what reasons may underlie this situation. Next, the interviewer asked about how specific criteria, picked out of the literature, related to the definition of LOT. These included the influence of treatment intention, the role of maintenance therapy, and local therapies. Another focus of the interviews was how the interviewees judged the relationship of both changes in drug regimen and therapy breaks to the definition of LOT.

Data collection/conduct of interviews

The expert interviews were conducted between June 1 and July 17, 2022 via video conference and in German. They lasted between 10 and 25 minutes with an average duration of approximately 18 minutes. The interviews were recorded and transcribed using the ExpressScribe Pro software (Version 10.17).

Data analysis

The interviews were analyzed using methods of qualitative content analysis as described in Mayring [ 10 ] and the software MaxQDA Analytics Pro 2022 (release 22.2.0). A system for coding the interview material was developed based on literature research conducted before the interviews.

Since the interviews were conducted in German, we provide an English translation of selected quotes. Table  1 contains the main topics and sub-topics of the interview, as well as exemplary quotes from the interviewees.

LOT definition and misunderstandings

Most interviewees confirmed that there was no common understanding of LOT and that they had difficulties explicating their own understanding of the concept. Furthermore, four of the interviewees reported misunderstandings with colleagues regarding LOTs and seven reported that they experienced uncertainties in their clinical practice when defining an LOT. For instance, if care for a patient was delivered by multiple centers, misunderstandings concerning LOT progression frequently occurred, because involved persons lacked a common understanding:

“[…] when it comes to categorizing it somehow so that it is standardized and applicable across multiple centers, yes there existed discrepancies in the particular considerations.” (Expert interview (E)05).

Treatment intention

Six interviewees said that treatment intention (curative vs. palliative) is important in the choice of therapy. Consequently, treatment intention is also relevant to LOT planning. Three experts expressed that LOT is especially relevant and established in the palliative setting:

“With a curative therapy option, […] you shouldn’t have any progression under therapy, after all. So that’s why the definition [of the line of therapy] does differ somewhat – palliative versus curative.” (E03).

Maintenance therapy

Starting a maintenance therapy to control a tumor after chemotherapy was predominantly not considered an indicator for a change in LOT, since usually only part of the medication regimen is discontinued for maintenance, while the rest remains the same. However, interviewees also said that maintenance therapy can include an entirely new pharmaceutical agent, which would, in turn, complicate the delineation between LOT:

“Yes, that’s difficult, too. I would probably count maintenance therapy as part of that – if it’s sort of quasi-logically linked to the therapy that was administered before it. But if it’s a completely different type of substance now, then it becomes more difficult again.” (E03).

Local therapies vs. systemic therapies

Six of the physicians interviewed opined that a LOT can contain both local and systemic therapies. However, some participants stated that beginning a new local therapy would not lead to a change of LOT, in contrast to beginning a new systemic therapy. Meanwhile, in contrast to the other six, three physicians emphasized that only systemic therapies can constitute a LOT:

“In my opinion, the therapy line is primarily defined by the systemic therapies. The local therapies are rather something supplementary that is carried out additionally, or – as the case may be – primarily in addition to symptom relief. Local therapies can also be used to achieve a response, but are not usually mentioned as a line of therapy.” (E06).

Change of LOT

All interviewees said that the LOT must be changed if tumor progression or disease relapse occurs or if therapy response fails. Six interviewees considered the occurrence of adverse effects (e.g., severe toxicity) a significant criterion for the decision to change an LOT. Only three interviewees saw the addition of a new pharmaceutical agent as resulting in a change of LOT:

“Dropping an active substance, I would always see as being due to toxicity or at the patient’s request – so actually owed to toxicity. That is, I would never call that a new line of therapy, whereas the addition of a new agent – strictly speaking, it would have to be considered a new line of therapy, although it is also difficult in terms of definition.” (E09).

The other seven interviewees only considered the introduction of new pharmaceutical agents a change in LOT if the treatment intention changed as well, or if a recurrence or progression occurred. Only the replacement of one drug with another of the same class (e.g., cisplatin with carboplatin) was not considered a change of LOT by anyone.

Therapy breaks

There were also ambiguous opinions regarding the role of breaks in therapy for the classification of LOT. On the one hand, the length of the break was considered decisive, whereas on the other hand, it was said that the therapy following the break was more important. Additionally, some viewed breaks in therapy as important for the classification of LOT in the event of a relapse or progression:

“[…] In principle, if no recurrence has occurred and it is perhaps even the same substance […] then I would consider it one line of therapy, regardless of how long the break was.” (E01).

If the break was unplanned, it was considered a significantly more important criterion for a change in LOT than if it was part of the therapy concept.

The expert interviews in this study largely confirmed that there is no common understanding of the LOT concept or its defining criteria. The interview material suggests that individual backgrounds in differing medical disciplines may influence views on and understandings of LOT. This potential context dependency of the LOT concept also appears consistent with heterogeneous working definitions of LOT in different real-world studies of distinct cancer entities [ 1 , 11 , 12 ].

However, it appeared that a LOT was considered a therapeutic concept with start- and endpoints that is focused on systemic therapies, although it may also contain additional treatment modalities. If included in the LOT, such non-systemic modalities would be selected based on individual patient and disease characteristics, and terminated if certain events (e.g., tumor progression) occurred.

There was evident uncertainty about the role of adjuvant and maintenance therapy and whether they should be regarded as an LOT together with the preceding (systemic) therapy. Also, no prevailing opinion could be identified on the questions of whether treatment intention (curative vs. palliative) and therapy breaks were integral to defining LOTs. Furthermore, experts held differing opinions on which changes in the administered drug regimen would initiate a change in LOT.

In the literature, however, individual approaches for standardizing the criteria for a change in LOT exist in the following cases: the termination of a LOT is indicated in the event of treatment discontinuation, addition of a new, non-equivalent agent, interruption of treatment, clinical progression of the disease, or death of the patient [ 2 , 3 ]. The interviewees were also nearly unanimous on these criteria: all considered tumor progression and recurrence decisive for a change in LOT; six experts highlighted the occurrence of side effects or relevant toxicity; three mentioned the scheduled end of therapy; and one cited patients’ wishes. Only some of the interviewees considered a change in pharmaceutical regimen a factor in identifying a change in LOT, while replacement of one drug with another from the same class was not viewed as altering the LOT.

The interviews both identified tumor recurrence and progression as LOT-relevant events and raised questions about the nature of their role. Recurrence and progression during therapy breaks, as well as the length of the break and the treatment thereafter, were considered relevant factors for a change in LOT. In two interviews, although the participants initially identified recurrence and progression as indicators for a change in LOT, their further comments appeared to contradict this standpoint. This apparent inconsistency should be investigated in future research.

Seven interviewees considered treatment intention relevant to LOT. Predominantly, interviewees considered the adoption of maintenance therapy as a continuation of an ongoing LOT. However, it remains unclear whether changes in the dosage or interval of drug administration during maintenance therapy imply a change in LOT. Six interviewees said that both local and systemic therapy modalities should be included in characterizations of LOT, although previous research excluded local modalities [ 1 , 13 , 14 , 15 ].

While similar approaches to standardizing the duration of a LOT [ 2 ] and first-line therapy [ 2 , 3 ] exist, it is not clear whether the definition of LOT can be standardized across disciplines as well as tumor entities. Nevertheless, a cross-disciplinary standard definition of the LOT concept should be targeted.

Limitations

This study exhibits the following limitations:

Qualitative expert interviews were only feasible for a small sample ( n  = 9) of oncological experts, most of whom were located at a single center (eight out of nine). While the study delivers highly granular insights, this approach precludes generalization of the findings. Therefore, subsequent research must evaluate the qualitative insights leaned from this study in larger and more representative samples.

The interviewees had varying degrees of professional experience and different specialties, making direct comparisons of experience and assessments regarding oncological LOT difficult. However, this was intentional to obtain the widest possible range of assessments regarding the broad topic under investigation.

No triangulation in the form of using multiple and diverse data sources, perspectives, locations, or theories took place in conducting the study. Such methods can help to mitigate subjective bias resulting from the explicit focus on one’s own data [ 16 ].

Data availability

Details on the data and materials related to the study may be available upon reasonable request from Bernd Bender ([email protected]).

Abbreviations

German Cancer Consortium

• Expert interview

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Acknowledgements

We would like to thank the expert physicians who participated in the interviews for their time and willingness to share their experiences and perspectives. Furthermore, we would like to thank the German Cancer Consortium’s Clinical Data Science Group for the support in realizing the study.

Open Access funding enabled and organized by Projekt DEAL. This research is partly funded by the German Cancer Consortium (DKTK).

Author information

Lisa Falchetto and Bernd Bender contributed equally to this work.

Authors and Affiliations

Institute for Digital Medicine and Clinical Data Science, Goethe University Frankfurt, Faculty of Medicine, Frankfurt, Germany

Lisa Falchetto, Bernd Bender, Ian Erhard, Jörg Janne Vehreschild & Daniel Maier

German Cancer Consortium (DKTK), partner site Frankfurt/Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany

Bernd Bender, Ian Erhard & Daniel Maier

Department for Dermatology, Venerology and Allergology, University Hospital Frankfurt, Frankfurt, Germany

Kim N. Zeiner

Department of Urology, University Hospital Frankfurt, Frankfurt, Germany

Florestan J. Koll

PIOH Praxis Internistischer Onkologie und Hämatologie, Cologne, Germany

Marcel Reiser

Clinic for Gynecology and Obstetrics, University Hospital Frankfurt, Frankfurt, Germany

Khayal Gasimli

Department for Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany

Angelika Stehle

Department Neuro-Oncology, University Hospital Frankfurt, Frankfurt, Germany

Martin Voss

Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany

Jörg Janne Vehreschild

German Center for Infection Research (DZIF) partner site Bonn Cologne, Cologne, Germany

Medical Department 2 (Hematology/Oncology), Center for Internal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany

Jan A. Stratmann, Sebastian Wagner & Olivier Ballo

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Contributions

BB, LF, and DM contributed to the writing of this article. LF and DM created the interview manual. LF conducted the interviews with the oncological experts and analyzed the interview material collected. DM and JJV were substantially involved in the conception of the study and in the acquisition of the interviewed experts. JJV also supported the piloting of the interview manual. IE edited the manuscript. KNZ, JAS, FJK, SW, MR, KG, AS, MV and OB participated in the study and provided the substantive statements and findings.

Corresponding author

Correspondence to Bernd Bender .

Ethics declarations

Ethics approval and consent to participate.

All subjects provided written informed consent to participate and this study was conducted according to all relevant ethical and regulatory guidelines. The project was approved by the ethics committee of the department of medicine of the Goethe University Frankfurt (ethical code number: 274/18).

Consent for publication

All interviewees permitted the use of the interview material and consented to publication.

Competing interests

Kim N. Zeiner (KNZ) received an honorarium for presentation from Bristol-Myers Squibb. Jan A. Stratmann (JAS) has personal fees from Boehringer Ingelheim, AstraZeneca, Roche, BMS, Amgen, LEO pharma, Novartis and Takeda. Florestan J. Koll (FJK) received grants from the German Cancer Aid and the German Cancer Consortium (DKTK). Marcel Reiser (MR) received consulting fees from Amgen, Abbvie, Stemline, Novartis and honoria from Roche. Jörg Janne Vehreschild (JJV) has personal fees from Merck / MSD, Gilead, Pfizer, Astellas Pharma, Basilea, German Centre for Infection Research (DZIF), University Hospital Freiburg/ Congress and Communication, Academy for Infectious Medicine, University Manchester, German Society for Infectious Diseases (DGI), Ärztekammer Nordrhein, University Hospital Aachen, Back Bay Strategies, German Society for Internal Medicine (DGIM), Shionogi, Molecular Health, Netzwerk Universitätsmedizin, Janssen, NordForsk, Biontech, APOGEPHA and grants from Merck / MSD, Gilead, Pfizer, Astellas Pharma, Basilea, German Centre for Infection Research (DZIF), German Federal Ministry of Education and Research (BMBF), Deutsches Zentrum für Luft- und Raumfahrt (DLR), University of Bristol, Rigshospitalet Copenhagen. Daniel Maier (DM) received speaker honoraria from Free University Berlin and travel compensation from IQVIA. Lisa Falchetto (LF), Bernd Bender (BB), Ian Erhard (IE), Sebastian Wagner (SW), Khayal Gasimli (KG), Angelika Stehle (AS), Martin Voss (MV) and Olivier Ballo (OB) have no competing interests.

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Additional file 1.

Interview manual with all instructions and questions.

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Falchetto, L., Bender, B., Erhard, I. et al. Concepts of lines of therapy in cancer treatment: findings from an expert interview-based study. BMC Res Notes 17 , 137 (2024). https://doi.org/10.1186/s13104-024-06789-6

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Barriers to equitable healthcare services for under-five children in Ethiopia: a qualitative exploratory study

• Hailu Fekadu 1 ,
• Wubegzier Mekonnen 2 ,
• Aynalem Adugna 3 ,
• Helmut Kloos 4 &
• Damen Hailemariam 2  

BMC Health Services Research volume  24 , Article number:  613 ( 2024 ) Cite this article

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Disparities in child healthcare service utilization are unacceptably high in Ethiopia. Nevertheless, little is known about underlying barriers to accessing child health services, especially among low socioeconomic subgroups and in remote areas. This study aims to identify barriers to equity in the use of child healthcare services in Ethiopia.

Data were obtained from 20 key- informant interviews (KII) and 6 focus group discussions (FGD) with mothers and care givers. This study was conducted in Oromia Region, Arsi Zone, Zuway Dugda District from June 1–30, 2023. The study participants for this research were selected purposively. The information was collected based on the principle of saturation after sixteen consecutives interview were conducted. Both KII and FGD were audio-recorded and complementary notes were taken to record observations about the participants’ comments and their interactions. Each interview and FGD data were transcribed word-for-word in the local Afaan Oromo and Amaharic languages and then translated to English language. Finally, the data were analyzed thematically using NVivo 14 software and narrated in the linked pattern of child health service utilization.

This study identified six major themes which emerged as barriers to healthcare utilization equity for caregivers and their -under-five children. Barriers related to equity in low level of awareness regarding need, low socioeconomic status, geographical inaccessibility, barriers related to deficient healthcare system, community perception and cultural restrictions, and barriers of equity related to political instability and conflict . The most commonly recognized barriers of equity at the community level were political instability, conflict, and a tremendous distance to a health facility. Transportation challenges, poor functional services, closure of the health facility in working hours, and lack of proper planning to address the marginalized populations were identified barriers of equity at organizational or policy level.

This study showed that inequity in child healthcare utilization is an important challenge confronting Ethiopia. To achieve equity, policy makers and planners need to change health policy and structure to be pro-poor. It is also necessary to improve the healthcare system to increase service utilization and access for impoverished women, individuals with lower levels of education, and residents of isolated rural areas. Furthermore, context specific information pertaining to cultural barriers and political ecology are required.

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Over the last few decades, the issue of equitable distribution and utilization of healthcare services has captured the attention of scholars, governments, and policy makers. While some countries have made much improvement in this regard, others have lagged behind. Child healthcare service use is no exception, and it has recently become a global concern [ 1 ].

Equity in health and health service utilization is a focus in the global health discourse as one of the cornerstones of primary health care (PHC) [ 2 ]. The United Nations has set a goal to reduce global neonatal deaths from 25 per 1,000 live births to 12 per 1,000 by the year 2030 [ 3 ]. Achieving this target will require strong commitment from both service providers as well as financiers of the health sector, including government and community leaders [ 3 ]. Among the World Health Organization’s main focus areas for under-five health, is the reduction of inequities in accordance with the universal health coverage principles. This includes addressing the health needs of children in poor and remote communities. Many countries have implemented various programs aimed at minimizing unnecessary disparities in health service utilization [ 4 ]. Community based health services in particular have been found to be effective in minimizing inequities in health status and health service utilization [ 4 ]. For instance, the Ethiopian government is committed to improve equity through the health extension program and other initiatives [ 5 ]. Moreover, Ethiopia included the equity objective in its health sector transformation plan [ 6 ]. Nevertheless, inequities in service coverage and difference in maternal and child health outcomes remain a challenge [ 7 , 8 ]. The coverage of child health services and basic child immunizations has favored wealthier, more educated, and urban populations. [ 9 ]. For instance, despite significant decline is observed in under five mortality from 123 per 1,000 live births in 2005 to 59 in 2019, still there exists a disparity between different population groups [ 9 ].

Ethiopia met the MDGS for child mortality rate (CMR) in 2013 [ 10 ]. However, the gains made between 1990 and 2013 were not uniformly distributed among Ethiopians; inequity indicators of mortality by wealth had not significantly decreased. During this 23-year period, the mortality among the poorest was unchanged. Even though child health services are supposed to be provided free of charge at public facilities, the disparity in access to or utilization of the services is high in Ethiopia. Like mortality disparity, there is a considerable disparity in coverage of life-saving interventions by wealth status and place of residence [ 11 ].

Addressing equity is a significant challenge in healthcare delivery in Ethiopia. The barriers that were reported to be significantly associated with service utilization included geographical access as a function of distance; financial barriers; and socio-cultural factors such as language, cultural norms, health beliefs and perceptions, maternal education and decision making power and lack of knowledge and awareness, which in the aggregate can lead to low demand for and use of services, particularly by the poor [ 12 , 13 ]. Long distances and extended travel times remain key barriers to access health facilities in many rural communities in Ethiopia [ 11 , 14 ]. For instance, in Indonesia proximity to healthcare facilities significantly decreases child mortality [ 15 ]. Furthermore, according to a study from Uganda, Nigeria and Ethiopia long distances to health care facilities cause delays seeking care [ 16 , 17 , 18 ]. Even where health care services are available, the cost of seeking care may delay or prevent poor households from accessing them. This problem is particularly discriminating in rural areas where the density of modern health care facilities is low and in settings where transportation systems and road infrastructures are poor [ 18 ]. Furthermore, over the last five years, Ethiopia has faced internal conflict and political instability which exacerbated inequity in the utilization of child health services among the poor and in rural communities. Both insecurity and scarce resources are critical issues in child healthcare accessibility for women living in conflict zones and socioeconomically unstable settings [ 19 ].

Political instability disrupts electricity, water, and food supplies, destabilizes social and welfare systems, including the health and transportation systems, and increases unemployment, homelessness, and poverty—all of which have a negative impact on the use of maternal and child health services [ 20 ]. Hence, these issues did not addressed in any of the studies done so far.

Thus, while many studies have been conducted on the utilization of healthcare services, there is insufficient comprehensive evidence on the barriers of equity in accessing and in utilization of healthcare services for under-five children from policy makers and community level perspective. Therefore, the objective of this study is to examine the context of specific barriers to achieving equity in child health-care services utilization in Ethiopia.

Inequity in child health care service is a major public health problem in developing countries, including Ethiopia. Accordingly, the study explored barriers to equitable healthcare services for under-five children, their health seeking behavior, geographical variation, their awareness, perceptions, attitude and political impact and policy contents of the country. The findings will benefit program leaders, policy makers on health inequality reduction and serve as an input to policy documents related to the new health sector strategic plan. Moreover, mothers and under-five children’s are directly benefited from the finding. Conceptual framework shows how different barriers affect equity in utilization of child health services (Fig.  1 ).

Modified Andersen and WHO conceptual framework, on social determinants of health inequity

The study setting and approach

This study was conducted in Oromia Region, Arsi Zone, Zuway Dugda District from June 1–30, 2023. The Ethiopian healthcare system is three-tiered, comprising primary, secondary, and tertiary care [Fig.  2 ]. The primary level healthcare system is responsible for providing child health services, such as immunizations, and the treatment of sick children. The primary care unit includes primary hospitals, health centers, and health posts which are responsible for providing services to rural communities ([ 17 ]; Arsi Zone Health Department report, Unpublished data, 2022). Women's development armies (WDAs) provide support to health extension workers (HEWs) by organizing and connecting women and their children with healthcare facilities. Based on 2022, the Arsi Zone report, Zuway Dugda district was low in utilization of child healthcare services and the population is low in socioeconomic status and mostly depends on the Safety Net program for nutritional and financial needs (Arsi Zone Health Department report, Unpublished data, 2022). The goal of the Safety Net program is to preserve family assets while generating new ones for the community. To achieve this, the program offers food or cash incentives in exchange for public works projects that improve the environment or create local infrastructure, like roads (e.g. terracing).

Ethiopian health care system [ 17 ]

Participant selection

The study includes 20 in-depth interviews of key informants (KII) and six focus group discussions (FGD). By taking into account various factors that contribute to variations in the use of child healthcare services, study participants were selected from a variety of demographic subgroups. The study participants were drawn from different segments of the population by considering different dimensions that explain disparities in utilization of child healthcare services. The selection of participants was based on their experience of child healthcare services as well as the information they possessed. For the purposes of this research, to ensure representativeness, and to understand the multifaceted levels of the study framework within society and how individuals and the environment interact within a social system, we used maximum variations sampling technique and we classified the participants into four groups. They were “mothers or caregivers who have under- five children”, “males who have under-five children”, “healthcare leaders at different levels” and “healthcare providers at different health facility”. The first group,, “women” refers to mothers who were gave birth prior to the study period and currently having under-five children. The second group were “males or husbands of the women who have under-five children”. The third groups, “healthcare leaders” like; heads of the health centers, district health office, expertise working on child health programs in district, Zonal, regional or national level. The fourth group, “health-care providers”, refers to health professionals, including doctors, health officers, nurses, midwives, and health extension workers working at different health facilities in Arsi Zone and having direct relation with child healthcare services.

Participants in the focus group discussions (FGDs) could be women and their partners who had under-five children at the time of the study. The participant mothers or caregivers were recruited by the HEWs and kebe le (neighborhood associations) leaders. They were identified on a purposive basis with the help of health extension workers and were contacted a few days before the planned FGD to explain the objectives of the study and request their participation. For the key informant interviews, the study participants were contacted by the principal investigator two weeks before the interviews. The information was collected based on the principle of saturation; for our case at least 16 interviewees were needed to reach information saturation principles. Then, data collection was terminated when no new information was generated.

An interview guide was prepared for both the key informant interviews (KII) and FGDs. First, the guides were prepared in English language and then translated into the local language [ 21 ]. Then, the guides were pre-tested and problems relating to the sequence of questions, conceptually similar questions, and sensitive wording were corrected. The data collectors for the KII and FGD were professionals with the background in health and health related fields with master and who are experienced in collecting qualitative data. Moreover, they are fluent in the local language and familiar with the culture of the local community. Key informant interviews were conducted at the office or at the health facility where the interviewee worked and FGDs were conducted in community halls or public rooms. Both key informant-interviews and focus group discussions were audio-recorded. Additionally, complementary observations and notes regarding the remarks made by the participants and their interactions were made.

Data analysis

The principal investigator and the moderator transcribed each interview and FGD word-for-word in the local Afaan Oromo and Amaharic languages and then translated the transcripts back into English. The translations were verified by listening to the recordings while re-reading the transcripts. The data were analyzed thematically using NVivo 12 software and narrated in the pattern linked to child health service utilization. Major themes representing the FGD participants and in-depth interviews are presented in the findings section, with illustrative quotes included to support the main findings.

Trustworthiness

In qualitative research, trustworthiness is determined by credibility, dependability, conformability and transferability. Establishing credibility involved the primary researcher spending a considerable amount of time at the study site to get a feel for the environment, receiving ongoing feedback from peers during peer debriefing, and applying negative case analysis. Dependability was demonstrated by providing an in-depth explanation of the techniques employed, keeping careful interview records, and recording the analytical procedure. All events that took place in the field, the researchers' personal reflections on the study, any phenomena that emerged during the investigation, and pertinent details of their personal histories were documented in order to verify that the interpretations of the findings were derived from the data and were not the product of their imagination. The investigators attempted to build rapport and trust with the informants by developing a long-term attachment because they were skeptical or doubtful if the information felt off. Triangulation of data sources was also employed. A thorough description that includes explaining each step of the research process was employed to aid in the transferability of research findings. At the end of each qualitative data collection session, the data collectors rephrased the collected information by summarizing major points and obtained approval from the participants for the corrected summary.

Characteristics of the study participants

A total of six focus group discussions (FGD)- three with mothers and three with fathers of under five children were conducted. And 20 key informant interview (KII) were held. The number of FGD participants ranged from 8 -12 in each groups. The majorities of women’s participating in FGDs were housewives and had at least one child under the age of 5 years in their care at the time of the FGD. The key informant interviews were conducted with leaders and policy makers at different levels of the health care system and a healthcare worker, including FMoH child health directors, Regional Health bureaus experts, Zonal Health office child health experts, woreda health office heads, Health center heads and health extension workers at health posts were involved. In all, 28 men and 30 women took part in the FGDs. In contrast, six HEW, three heads of health centers, one head of the district health office and with ten experts participated in the key informant interview. Each FGD took on average 42 min (38–52 min), while the key informant interviews took about 36 min (19 to 55 min) (Tables 1 and 2 ).

Barriers to equitable healthcare services for under-five children

Six major themes emerged from the findings.

These include; barriers related to low awareness, low socioeconomic status, geographical inaccessibility, barriers related to deficient healthcare system, cultural and behavioral constraints, and political instability and conflict, all of which lead to unmet healthcare needs such as delay in receiving appropriate care and inability to obtain healthcare services (Table  3 ).

Lack of awareness about benefits of the services

Lack of awareness and misconceptions were one of the top reasons raised by KII and FGD participants for not using healthcare services for under-five children especially in rural communities. Recognition of illness and the potential benefits of treatment are pre-requisites for health care demand. Communities who lived in remote areas and are undereducated tend to have little knowledge concerning health issues. Rural people have insufficient exposure to the media, attending low level of schooling to grasp and understand health related information. The key-informant interviewees and FGD discussants reported that because of low health literacy, rural community and the poor households have less access to health facilities to get treatment for childhood diseases, and for immunization services. One of the key informants mentioned that there are variation or differences among urban and rural rich and poor, literate and uneducated people in child health care service utilization.

“… . Children who visited our health center with malnutrition were from remote and far to reach areas and were brought to our health facility only after these cases were seriously complicated. So there is great variation among urban and rural, rich and poor, literate and illiterate communities in child health care service utilization in our district .” Male , KII, age 34years

One FGD discussant from women group added her experience and her awareness of immunization and availability of free service in health post in such ways;

“Yes, if I had been aware of the benefit of immunization and informed that they were given free of charge, I would have used these services for my sick child from health posts, not from traditional healers” Female FGD discussant, age 35 years, Seeking care from traditional healer

The health extension workers at health posts also approved the lack of awareness among mothers and caregivers on the availability of health service which jeopardizes health- seeking and utilization of health service for their under-five children. One worker said that.

“Most of the women’s and care givers did not know about the availability of treatment at the health post, especially for diarrhea and pneumonia. Those women’s who live near a health facility, are educated and young have more awareness about childhood illnesses and seek care from health posts than uneducated mothers; this may result in inequitable utilization of health services by illiterate care givers ” KII, Female 35 years

In some areas there is a mix of knowledge about utilization of healthcare services for under-five children. Health professionals used abbaa gadaa, or hadha sinqee (male and female cultural leaders) and members of the female development army (FDA) to raise the level of awareness in the community. One key informant interviewee shared the experience of his districts in utilizing women’s development army and these cultural leaders to increase the knowledge of the community as follows;

“We improve the awareness of our community on child healthcare utilization through women’s development army and cultural leaders, we trained these women about early recognition of maternal and child health danger sign. we provide them local COC for them. By now in our district, women’s development armies have equivalent knowledge with HEW and, we used them to teach the community”. Male, Key informant, age 42 year.

Socioeconomic barriers

Lack of sufficient income at household level and low level of maternal and paternal education were identified as major barriers for equity in utilization of healthcare services for under-five children. As part of its HSDP II strategic objectives, the Ethiopian Government intends to address equity in maternal and child health, particularly for the impoverished and rural communities, by providing free health services to these subgroups and allocating a sufficient budget. However, the actual and perceived cost of seeking care keeps some people from traveling to medical facilities. Out-of- pocket costs of health care, cost of transportation and living cost may prevent poor people from using services, leading to untreated childhood illness.

For instance after they reached to health facility, they obligated to pay for medical treatment or drugs they used to treat their children. In this case some advanced diagnosis and treatment is not available in governmental health facilities.. For example, CT scan and MRI to diagnose severe childhood diseases and some essential drugs to treat pneumonia, sepsis and diarrhea were not available in health centers and in health posts. They were advised to get this treatment from private clinics and to buy the drugs from private pharmacies. However, or mothers could not afford to purchase them from private clinic.

A woman from FGD discussant explained her experience of an availability of certain services in Government health facility and high cost of services in private clinic as follows:

“Yes, nowadays, the cost of drugs and treatment for childhood illness is increasing, when I used to get treatment for my sick child from a health center or health post the health professional referred me to a private clinic to be seen or diagnosed by a highly expensive machine; I am unable to afford for this machine. Moreover there were no drugs at the health post and the health center. They told us to purchase them from private clinics. So, how can the poor people get treatment from Governmental health facility?” Female FGD discussant age, 34 years, with low income.

Another FGD discussant described this problem as follows:

“Yes, getting treatment in this health facility is good but sometimes you go here and there to get examined and prescribed for drugs and you need money for those drugs. If you don’t have money, then you remain with the illness” Female FGD discussant, age 29 years.

The study participants suggested that, socioeconomic healthcare inequity must be addressed by healthcare system revisions such as the provision of health insurance, fee retention; waiving and exemptions from fees for poor people, and subsiding the cost of the transportation were considered as solution to reduce inequity in health care services.

Geographical barriers

Distance of health facilities from home and unavailability of motorized transportation were another major barrier to health services utilization. Pit the fact that availability of some community based services should increase health service utilization to caregivers, distance from homes to health facilities, poor roads and unavailability of motorized transport were major barriers for many people. Distance from health centers and health posts and lack of transportation and cost of transportation were cited as barberries of equity for child health service utilization by rural and the poor communities. Long distances, shoddy road construction, and a shortage of ambulances make it difficult for residents of remote communities and low-income families to get to medical facilities and thus have fewer opportunities to vaccinate their children. One key informant said that.

“…the primary issue facing this district is the lack of transportation and the distance between the residential area and the medical facilities . The caregivers were unable to get transportation service easily. In some areas the distance between health facilities and residential areas of the community is too far, besides there is no road to get access to health facility. We need more vehicles at health center level; moreover, the transportation issue cannot be solved unless quality roads will be constructed for the community.”Male, key-informant interview, age 40 years.

Another FGD discussant said that.

“ Yaa, we move more than 30 km on foot to access health facilities, especially health centers, there is no road for cars., we carry our sick child on our backs to get treatment from this health facility” FGD, Male, age 44 years.

One FGD described the transportation problem a follows:

“…even though roads were constructed, there is no reliable transportation system in our area. Ambulance service is not available in our area, no mobile network to call to ambulance service. Moreover, if we were hardly access the ambulance, we are requested to pay 1000 Birr for fuel. Therefore, the Government and concerned body has to understand and solve our situation related to distance and transportation problem.” Male, FGD discussant, Age 49 year.

The study participant also suggested that geographical and financial accessibility barriers have to be addressed by bringing services closer to homes or residential areas.

Healthcare system barriers

Certain aspects of healthcare system were identified as barriers to equitable healthcare services for under-five children. In Ethiopia, important deterrents include unavailability, unaffordability of the service, and closure of health posts during working hours and issues related to behaviors of the health professionals were the emerged theme from this study.

One of the important barriers of equity in utilization of child healthcare services especially by poor were unavailability of child care services at health posts. Even though the health posts are supposed to give services for the rural and poor populations, it was closed on many working days and at weekends. In addition, absence of health extension workers from the duty during working hours, services inconsistently and unavailability of drugs in the health posts were barberries of equity raised by KII and FGD discussants. One of key informant interviewees explained his observations as follows;

“Even though, the health posts are expected to give maternal and child health services for the rural community free of charge, how the poor and the rural community get these services, the health posts were closed during working hours, most of the time the HEW workers are in another duty, they were assigned to collect taxes and insurance from the community, so the richest household will get these services from private health institution but the poor and the rural community is in problem in accessing these services” Key-informant interview, Male, 45 years.

Besides giving health services, in some rural areas the health extension workers are assigned to other administrative and political activities. A health extension worker in health post acknowledged the absence of health services during working hour in such ways;

“ How can we give health services for the poor community, we are assigned to collect insurance, taxes and to register member for the political parties, if we say no we will be fired, most of the time the health posts were closed, all services were intercepted, mothers from rural area repeatedly came for immunization, but they did not get us in the health post, those mothers who were educated and have the money for transportation may went to health centers and Hospitals to get immunization service, but the poor mother were waiting us till the health post is opened” Female, Age 39 year.

One woman from FGD participant also explains her experience as follows;

“One day my 3 years old child was sick and I came to consult the HEW, but, the door is closed and she was not around” Female, FGD discussant, Age 38year, rural community

Another important finding from this qualitative study was issue of marginalized populations. The health services do not cover marginalized and poor people, like, beggars, around churches, mosques and along roads on child health services especially immunization . Key informant participants from the one woreda health office described this issue as follows;

“Here is the gap, now the health facilities have no plan and willing to give immunization services to marginalized poor people like; beggars around the mosque, church, and on roads. These poor people are totally forgotten, the motivation of health workers to serve this community is almost zero or near to nil. All vaccination mandates are given to HEW, but now health centers and health posts are not connected to these people and their children’s are not vaccinated at all. There is no supervision or support from higher officials, no accountability among HEW “KII M ale, 45yer.

Lack of adequate supply of medicines and other medical supplies emerged as a recurring theme in FGDs and KII at both the policy and service delivery levels. The health posts do not have all basic medicines available and end up giving inadequate drugs, no separate budget is allocated for child health by Ministry of Health or the regional health bureaus. Donors, NGO,s and partners have reduced their budgets and support of child health programs.

One KII participant shared his perceived cause of inadequate supplies and budgeting for health facility as follows:

“…Currently only limited budgets are allocated to the health sector, especially for maternal and child health. There are no donors and partners who support the healthcare system; this is probably linked to the current Ethiopian political upheavals. This creates problems for free services for maternal and child care. In my opinion this is the cause of an availability of materials and some drugs at health facility” key-informant-interview, age 44 year.

Disrespectful care and treatment was the issue raised as barriers to equity by caregivers for their under-five children. Ethiopian communities pay attention to respectful and quality of care, therefore giving preference to urban health centers, which generally meet patient expectation. But urban health facilities also discriminate against poor people. A female FGD discussant raised the issue of non-compassionate and disrespectful care given to her at an urban health facility, as follows:

“Yes, we looked unclean and came from rural areas, the health professionals treated us as not as humans and gave us poor care. They did not touch us by their hands or used apparatus to examine our problem. They simply asked us about our illness and gave us prescription to buy drugs” Female, FGD, 42 years.

Respondents suggest that, the government need to ensure the availability of adequate essential vaccines, drugs and supplies in health facilities. The FGD discussants further emphasized that, both central and local healthcare systems need to allocate adequate financial resources and procure adequate logistic and material supplies towards effective implementation of quality healthcare services.

Cultural and behavioral barriers

Low demand and utilization of modern health interventions often derives from deep-rooted attitudes that reflect culture, social norms and traditions of the community. Few FGD participants mentioned that cultural barriers such as using traditional medicines at home and taking the children to traditional healers were barriers to using child health services, especially in rural areas. In some areas peoples believed that the cause of the illness is caused by supernatural agents, exposure to cold, wind or the devil eye. Therefore they do not bring their children to health facilities. Many poor mothers and care givers in rural areas use traditional medicine or religious interventions such as payer as the first treatment for childhood illness because of their ready accessibility and low cost, as stated by one father:

“I have encountered people in some districts who delayed treatment because of traditional beliefs. One of them said … If my child gets sick, I will not bring it to a health facility immediately, I will wait until the disease matures and shows full blown sign can l be observed or till it will resolved by itself” key-informant interview, Male 42 years.

There are also other traditions, customs and beliefs among some rural communities which are barriers to equity of child health services. For instance haamachisaa is a kind of blessing used as the first treatment by traditional healers for neonates aged less than 3 months before seeking care services from health facilities. They believe that haamachisaa prevent malicious birds or the evil eye to inflict illness on neonates, as described by one mother:

“ in our area some of the rural communities will not send their “ children below three months of age” to get immunization services from health facilities before they practice haamchisaa or blessing services from a traditional healer because a bird or the evil eye may see the neonate “ Female, key- informant, 39 years.

In some rural districts, obstacles to child health care service utilization include the use of traditional uvulectomy, getting treatment for measles from traditional healers and using holy water (tsebel) at churches when children fall ill.

“In our area, when their child develops measles some of them refuse to take their children to health facility because they believe that the treatment there will cause girsha, the dissemination of the rash to different organ systems” Male, key-informant, 30 years head of HC.

Another FGD discussant described her preference of traditional healers for her sick child because of cost of the drug as follows;

“I visited a traditional healer for my child when he had tonsil, because drugs and repeated treatment from a health facility are expensive; After the tonsils are removed by a traditional healer there is no recurrence, so it is less costly for me” Female, FG, Age 40 year.

In another way less attention was given for morbidity and mortality of the child by rural community, especially to the neonate (if a neonate died) the funeral ceremony will not be practice in the church or mosque. The burial or funeral ceremony is accomplished at near house of the parents; the dead body is not brought to church or mosque. The community did not consider a neonatal death as a death of human being or adult death but, is concealed, as described by a male key-informant:

“ Here in the community less attention is given to child health, especially for the newborns; if the newborn dies the dead body will not brought to a church or mosque but it will be buried around the home. Nobody will go to that home to morn with the parents” Male key-informant, 42 years.

In many Ethiopian communities, women’s have low autonomy to decide for her own and their children’s health in Ethiopia. They need the permission of their husbands to seek care for their children, because of economic, psychological and material dependence. The norms and values of the community also reinforce this behavior.

One of the important finding of this study was inequity related to ethnicity. Almost all KII and FGD participants stated that there is no disparity in healthcare service utilization because of ethnicity.

“…..Even though Ethiopia is having a diversified ethnic group still there is no marginalization or inequity in utilization of child health services from health facility because of ethnicity; rather they encounter barriers related to language in understanding and to get consultation from service providers” Key-informant, Male, Age 39 year.

The study participants further suggested that barriers related to health illiteracy or mistrust of the healthcare system have to be addressed by involving different stakeholders such as community leaders, traditional healers and religious leaders .

Politics, conflict and security issues

Over the last few years, Ethiopia is suffering from different types of military conflicts between the Ethiopian government and insurgent forces in most regions and administrative areas. This protracted conflict hinders maternal and child health service delivery affected communities, especially in isolated rural areas. As a result, health services could not operate safely in the war zone, Increasing the incidence of vaccine-preventable diseases and malnutrition. A male FGD discussant explained the effects of conflict on maternal and children service utilization as follows:

“ In our district there is continuous military conflict between the government and rebel forces; most of the time the health facilities were closed, there is diversion of supplies for maternal and child health services to the armed forces, no immunization services was given to the community during this conflict period, roads were closed, the health professionals fled health facilities because they felt insecure, even ambulances assigned to MCH services were used for military purposes;, the rich may get the service from private clinic, the poor did not get anything, simply waiting an interventions from God,, or simply wait to die or migrate to other places” Male, FGD, age 45 years.

One key-informant interview participant reported his observation of security problem on child health services in his district as follows:

“Regarding the issue of security problem, currently in our area there is a military conflict between government and rebellions. Due to this there is no maternal and child healthcare services, 24 h ambulance was served for political purposes, as a result mothers and children are dying from severe anemia and severe pneumonia at their home, therefore, politically instability and conflict among Government and armed rebellion force exacerbate the existed disparity in utilization of healthcare services for mothers and children in our district”. Key –informant, male, age 41 years.

The research participant added that communication between opposing groups is necessary to resolve political unrest and conflict which has direct impact on child healthcare utilization.

This study aimed at exploring barriers of equity that mothers and their children face in accessing and utilization of healthcare services for under-five children. The findings point out multiple dynamics of barriers of equity to care-seeking and utilization of healthcare services in Ethiopia.

In this study the barriers and challenges linked with access and utilization of equitable healthcare services for under-five children were found to fall under six themes ; lack of awareness about availability of the service, socioeconomic barriers, geographic barriers, health system related barriers, cultural and behavioral barriers and political instability and military conflict related barriers. These barriers are inter-related and complex in nature. As key-informants and FGD discussants reported that lack of awareness was one of the top barriers for not using healthcare services for under-five children, especially in rural communities. Populations who have settled in far to reach areas and uneducated have no equal awareness about health related issues compared to urban and well educated populations. Their reasons are people leave in rural area has insufficient exposure to media, attending low level of schooling to grasp and understand health related information. Most studies reported that because of low health related literacy, rural community and the poor household had delayed to access health facility to get treatment for most of childhood illnesses, and vaccination services [ 22 ]. In this study having participants confirm that there is a gap in knowledge regarding the causes of childhood illness and regarding the availability of treatments at health posts, it is clear that a campaign to educate and mobilize community members will be necessary. The need for transmission of information about the availability of services was also highlighted by several other studies [ 23 ]. Studies in Ethiopia reported that, HEW home visits were reportedly valuable for increasing awareness and use of services and mothers of under-fives who received health information [ 24 ]. Different studies suggest that community education and mobilization campaigns may increase level of awareness of communities. One study also reported that HEWs and HDA were credible sources of health-related information [ 25 , 26 ]. For example, the HEW increased the awareness of communities during pregnant woman conferences, vaccination campaigns, and other community meetings.

This study further highlights that, socioeconomic barriers to health care utilization are strong deterrents that increase under-five mortality in Ethiopia. Limited financial resources for medical treatment and low educational level of parents are barriers to the use of healthcare services for children among disadvantaged populations. In this regard, the Ethiopian government plans to provide free health services for women and under-five children, through the HSTP. II but our finding revealed that low household income, low level of maternal education, and out-of- pocket payments for health care prevent poorer people from using services for under-five children. Furthermore it should be noted that the government of Ethiopia has adopted a waiver fee policy for the vulnerable groups. However, cost of services still play a major role in access to service since the exemption from paying for the services is unevenly applied.

Several studies corroborate our findings of the socioeconomic impact on health service utilization [ 27 , 28 ]. A study conducted by Daniel et al. confirmed that the levels of household income and health literacy affect access to healthcare services [ 27 ]. Moreover, indirect costs such as loss of work time, loss of income and transportation cost have a significant economic impact on poorer families [ 28 ]. Implementing health insurance scheme and waiving user fees may shield the poor from these charges and weaken household health budget constraints.

Our findings of the negative impact of low education of parents is corroborated by several studies. [ 29 , 30 ]. Pregnant mothers with higher education are more aware of the significance of good nutrition and child care as well as the prerequisites for being healthy [ 31 ]. Education plays a vital role in shaping attitudes, opinions, customs, and norms and also promotes the adoption of new ideas and values.

The result of our study revealed that, distance from health facility, lack of transportation and uncomfortable road topography especially in summer were mentioned as an important barriers of equity in healthcare service utilization for under –five children. Previous studies in Ethiopia confirmed that far to reach regions, districts and areas often face special issues and problems compared to non-far to reach areas [ 32 , 33 ]. Several studies in other countries also showed that travelling to a health center was challenging for caregivers of children residing in far to reach areas and cost of transportation, unreliability and its unavailability of services were the main impairments of equity in accessing healthcare services [ 34 , 35 , 36 , 37 , 38 ]. For example, a study of measles vaccination coverage in various African countries found that distance was a key factor in determining the level of immunization coverage [ 39 , 40 , 41 ]. In addition to the inverse relationship between distance and health services utilization, geographical location of health facilities in isolated rural areas also jeopardizes the staffing of health facilities. Doctors, midwifes and nurses are less eager to serve in such areas than in urban communities and vaccines and flooding may prevent the delivery of vaccines and drugs to distant mountain communities during the rainy season.

Respondents highlighted the need to ensure reliable availability of HEWs at the health post during opening hours and extending the hours of the health post so that services would be available working hours and on weekends. Such closures have been shown to be a major challenge in previous studies [ 42 ]. HEWs travel for activities such as collecting taxes registering political membership from the residential and payment for health insurance from the community should be stunned by the community and so that there is at least one HEW in each health post to give services for the community . Another important finding from this study was issue of marginalized populations. Some key-informant and FGD discussant cited that, the health facility is not have especial plan to address the services to marginalized poor people, like, baggers around the church, mosques and around roads on child health services especially for immunization services. Hence this may create critical inequity in child healthcare service utilization among the poor.

Barriers to equity in access and utilization of services extend beyond accessibility and availability issues, disrespectful care and negative attitude acts as a barrier to accessing health care services. Negative attitude of health workers in the form of verbal expression, represented a theme of recurrence as a barrier of equity in utilization of the services. Female FGD discussant raised the issue of non-compassionate and disrespectful care given to them by health professionals at health facility and they were receiving poor quality of care, and there is no companionate care for the poor. Improving quality and outcomes at health centers offers an incentive for the utilization of a service. In many African countries, low quality of health services has been identified as a hindrance to equitable access of services [ 43 ]. In the current study, few participants mentioned that cultural factors like home remedies taking the children to traditional healers were obstacles to utilization equity. Other studies from Sub-Saharan Africa show similar results [ 44 ]. This shows that, traditional beliefs and norms of the community impede from seeking-care modern healthcare and utilization of the services from health facility.

One of the promising finding in this study was, even though Ethiopia have a diversified ethnic group there is no report related disparity or inequity in utilization of child health services because of his/her ethnicity, rather they encounter barrier related to language in understanding and to get consultation from service provider.

Our finding revealed that, war and political instability disrupt health services accessibility and utilization. There was also reported from several other countries, including Afghanistan, the Democratic Republic of Congo, Pakistan, and Somalia [ 45 ]. Key impacts include disrupted infrastructure and supply chain; violence against health workers; difficulties retaining health workers; delivery service interruptions; and displacement and migration [ 46 ]. For populations affected by military conflict, adopting flexibility surrounding age and eligibility criteria can increase immunization coverage.

Strength and limitation of this study

Strengths of this study include the collection of data by experienced interviewers, efforts made to increase trustworthiness of the study, checking transcripts against audio-records and field notes by two independent experts, and use of the participants’ own language for data collection. In addition, inclusion of participants from all levels of the healthcare system and caregivers (both mothers and father) of the children broadened the range of experiences and opinions on inequity in child health services accessibility and utilization. The major limitation of this qualitative study is that its findings are may not be generalized to other settings. Furthermore, since the study was only conducted in one district, it might not be representative of the entire nation.

Conclusions and recommendations

We conclude that inequity in child healthcare utilization continues to be an important challenge confronting Ethiopia. Constraints such as poor community awareness of the availability of curative healthcare services, geographic inaccessibility, inadequate healthcare resources, socioeconomic barriers, and constraints related to the functioning of the healthcare system and political instability and military conflict were the most cited barriers to equity.

To achieve equity, Ethiopian policymakers and partners need to invest in health infrastructure, including bringing services closer to people by constructing new health posts, health centers and roads in rural areas, and increasing the quality of services. In addition, context-specific cultural barriers such as the use of traditional medicines and illness beliefs need to be addressed through health promotion and military conflict needs to be solved through dialog between opposing bodies.

Availability of data and materials

The data that support the finding of this study are available and attached as related files.

Abbreviations

Certificate of competency

Compassionate respectful care

Focus group discussion

Federal Ministry of Health

Health care workers

Health extension workers

Key-informant interview

Maternal and child health

Millennium developmental goals

Oromia Regional Health Bureau

Primary health care

United Nations

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Acknowledgements

The authors would like to thank the study participants, the Federal Ministry of Health, regional health bureaus, and zonal and district level health leaders. We also acknowledge Addis Ababa University and Professor Helmut Kloos for funding this study.

Addis Ababa University School of Public Health, and support from Professor Helmut Kloos.

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Hailu Fekadu

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Wubegzier Mekonnen & Damen Hailemariam

Department of Geography, Planning and Environmental Sonoma State University, Sonoma, San Francisco, USA

Aynalem Adugna

Department of Epidemiology and Biostatistics, University of California, San Francisco, USA

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H.F and D.H contributed to the design and conception of the study and analyzed and interpreted the data. W.M, H.K, and A.A participated in data analysis, interpretation and revision of the manuscript. All authors read and revised the draft of this manuscript and approved the final version.

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Fekadu, H., Mekonnen, W., Adugna, A. et al. Barriers to equitable healthcare services for under-five children in Ethiopia: a qualitative exploratory study. BMC Health Serv Res 24 , 613 (2024). https://doi.org/10.1186/s12913-024-11074-0

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• Volume 9, Issue 5
• Trust in healthcare: methodological and conceptual insights from mixed-method research in Lao People’s Democratic Republic
• Article Text
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• http://orcid.org/0000-0002-5849-7131 Marco J Haenssgen 1 ,
• Elizabeth M Elliott 2 ,
• Sysavanh Phommachanh 3 ,
• Sylivanh Phomkong 4 ,
• Sengchanh Kounnavong 5 ,
• http://orcid.org/0000-0003-1770-4381 Shogo Kubota 2
• 1 Department of Social Science and Development , Chiang Mai University , Chiang Mai , Thailand
• 2 World Health Organization Regional Office for the Western Pacific , Manila , Philippines
• 3 University of Health Sciences , Vientiane , Laos
• 4 World Health Organization Representative Office , Vientiane , Lao People's Democratic Republic
• 5 Lao Tropical and Public Health Institute , Vientiane , Lao People's Democratic Republic
• Correspondence to Dr Marco J Haenssgen; marco.haenssgen{at}cmu.ac.th

Background Global health foregrounds trust as a key requirement for the achievement of international health initiatives, but it remains an elusive concept that is often mobilised without consideration of its dimensions, drivers and downstream behavioural consequences. This paper aims to contribute to the conceptual development and measurement of ‘patient trust in primary healthcare’ from the lower middle-income country perspective of rural Lao PDR.

Methods A two-phase mixed-method research design was implemented between January 2021 and April 2023. Phase 1 involved exploratory qualitative research to understand the local expressions and dimensions of patient trust in primary healthcare, with 25 semistructured interviews and 17 focus group discussions (120 participants) in eight villages in Bokeo Province. Phase 2 involved explanatory research to assess patterns of trust systematically at scale in 14 villages across four provinces, wherein 26 cognitive interviews, 17 expert interviews and non-participant community observations informed a community census survey with 1838 participants. We analysed qualitative data through content-oriented thematic analysis and developed an 8-item trust scale on that basis. Quantitative data analysis used descriptive statistical and regression analysis.

Results We found that trust in primary healthcare is readily understood and intrinsically valuable in rural Lao PDR. Key dimensions included communication, respectful care, relationship, fairness, integrity, reputation, assurance of treatment and competence. The survey highlighted that reputation, competence, integrity and respectful care had the lowest trust scores. Health centre operations predicted the local expressions of trust. The behavioural consequences of trust were limited to a positive statistical association with antenatal care uptake among pregnant women but outweighed by alternative measures that also captured the availability of healthcare facilities.

Conclusions Overall, the development of our quantitative trust scale offers a process model for future researchers. We conclude that interpersonal, institutional and service-related trust require more explicit recognition in health system development and integration into health policy.

• Health systems
• Qualitative study
• Other study design
• Community-based survey

Data availability statement

Data are available upon reasonable request. The datasets generated and analysed during the current study are not publicly available to protect the anonymity of our respondents but are available from the corresponding author on reasonable request.

This is an open access article distributed under the terms of the Creative Commons Attribution IGO License ( CC BY 3.0 IGO ), which permits use, distribution,and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.

https://doi.org/10.1136/bmjgh-2023-014640

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WHAT IS ALREADY KNOWN ON THIS TOPIC

Global health research and policy foreground concerns about waning population trust in healthcare and science.

Trust is a multidimensional concept, but its component dimensions are not well understood and research perspectives outside of high-income contexts are rare, which creates blind spots in literature and practice.

WHAT THIS STUDY ADDS

We conducted original mixed-methods research to ground the understanding of trust in the local realities of a lower middle-income context.

Trust in rural Lao PDR is readily understood, intrinsically valued and comprises eight distinct dimensions.

The behavioural impacts of trust are mild and concentrated in antenatal healthcare access but can be leveraged relatively economically.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

We provide a methodology for developing and deploying locally grounded trust measurement at scale.

Building interpersonal, institutional and service-related trust in healthcare can complement physical aspects of health system development but requires more attention through formal integration in health policies and initiatives.

Trust-building interventions require substantial groundwork with target populations to identify key dimensions and issues in their trust towards health services.

Introduction and objective

The notion of ‘trust’ has been argued to contribute positively to patients’ health service uptake, healthcare experiences, ‘better symptom-oriented subjective outcomes’ and even lower mortality in some cases. 1–3 With renewed interest in the subject due to the rapid expansion of international health initiatives and the emergency responses to the COVID-19 pandemic, global health research and policy now foreground concerns about waning population trust in healthcare and science. 4–6 However, trust remains an elusive notion that is often mobilised as a rhetorical device without consideration of its dimensions, drivers and downstream behavioural consequences.

The objective of this article is to contribute to the further development of the conceptual and methodological foundations of ‘trust in healthcare’. Drawing on the case of Lao PDR where exploratory sociomedical research has laid the foundation for a nation-wide initiative to enhance utilisation of rural primary healthcare services through community engagement, we address the question, ‘ What are the local expressions and patterns of trust in rural Lao PDR?’ In answering this question, we document a detailed mixed-methods approach to explore whether and how trust matters in local healthcare contexts of a lower middle-income country—a perspective that the literature has largely neglected. Our study, thus, identifies and illustrates eight distinct dimensions of trust in primary care services, and it offers a methodology to assess patterns, drivers and the behavioural implications of community trust in primary care services at scale.

Conceptual and methodological background

‘Trust’ as either a noun or a verb is a broad concept with a wide range of meanings, making it complicated to define or measure. 6 Pilgrim and Vassilev 7 detail the multiple connotations of trust, which are subjectively experienced and implicitly related to power, risk and ethics. In healthcare, this includes both interpersonal trust in the healthcare provider, trust towards the product or service provided and systemic or institutional trust in the health system. 8 9 Within the asymmetrical interaction with a healthcare provider, trust is inversely associated with the perception of risk by the patient and can, thus, be defined as ‘a set of expectations that the healthcare provider will do the best for the patient, and with good will, recognising the patient’s vulnerability’. 10 As such, trust is subjected to not only external influencing factors such as health information or political action but also past health system operations and personal experiences therein. 8 9

The most common method to measure trust in healthcare providers is a quantitative ‘trust scale’ that aggregates responses to a set of structured survey questions. 6 11 A systematic review identified 45 different measures of trust in the health sector and 12 questions on average per scale. 12 Among these measures, the most widely used is the ‘trust in Physician Scale’ 13 —an 11-item self-reported instrument developed to assess an individual’s trust in their physician, for instance, by gauging agreement with such statements as ‘I trust my doctor (provider)’. However, broad assessments such as ‘I trust my doctor’ are likely to mask the reasons for good or poor trust (note that items in this scale as used, eg, by Anderson Dedrick, 13 examine other dimensions of trust as well). Qualitative research can usefully complement quantitative work, for instance, by helping identify and develop contextually appropriate trust scales and their components. An example is the mixed-method approach of Greene and Ramos, 11 who found that trust in US healthcare providers was highly correlated with the trust components of communication, caring and competence. A systematic literature review by Ozawa and Sripad 12 documented in total eight such components, including honesty, communication, confidence, competence, fidelity, system trust, confidentiality and fairness.

Most studies in this field focus on high-income country contexts and especially the USA, 6 the latter of which represented 37 out of the 45 studies, which Ozawa and Sripad 12 reviewed (only three reviewed studies were not from high-income settings). Gopichandran et al. 14 argue that low and middle-income health systems commonly exhibit ‘deprivation of resources, lack of universal health access, low public expenditure on healthcare, high out of pocket expenditure on health and poorly regulated private practice’. As low and middle-income health systems thus differ systematically from high-income contexts (even where universal health coverage alleviates healthcare utilisation issues relating to affordability), they produce economically, politically, socially and also emotionally different health system encounters for local populations that afford further systematic research into the nuancing elements affecting trust in healthcare providers.

Among the rare examples outside of high-income settings is the qualitative study in rural south India by Gopichandran and Chetlapalli, 15 which identified five key dimensions of trust that deviated from common trust scales in high-income settings, namely ‘perceived competence of the doctor, assurance of treatment (irrespective of time or ability to pay), willingness to accept drawbacks in the doctor, loyalty and respect’. Studies in Cambodia furthermore reported different levels of trust towards public and private health facilities, whereby private providers were deemed relatively more convenient, approachable, easy to contact and would accept delayed payments. 16 17 Research from Mozambique found instead that the main influence on trust derived from healthcare providers’ communicative performances during their interactions with patients. 18 These isolated yet rich examples demonstrate that more research in low- and middle-income contexts can help provide important nuance to the understanding of trust in healthcare.

In Lao PDR, qualitative research into healthcare-seeking experiences demonstrated that trust had strongly pronounced interpersonal components: people were found to select healthcare based on their relationship to, the reputation of, and recommendations by trusted people for the various local healthcare providers. 19 20 Conversely, patients would be afraid of receiving poor care or paying extra fees if they did not have any previous connection with the provider. 21 Other qualitative and quantitative studies have further shown that trust in providers was also affected by the providers’ communication and counselling skills as well as their attitudes. 22–24 Providing services that people want and need, and regular interaction with the local community, was also argued to encourage healthcare utilisation and to build trust from both a service and institutional perspective. 25

Patient and public involvement

The research took place across rural Lao PDR and in conjunction with a nationwide initiative to strengthen primary healthcare services that the Lao Ministry of Health (MoH) and Ministry of Home Affairs (MoHA) implemented with technical support from the WHO. 26 This initiative was borne out of healthcare challenges experienced during the COVID-19 pandemic and involved support for localised healthcare governance and a multisectoral approach to empower communities to jointly improve health of the people in Lao PDR. 26 Relationship building and healthcare ownership through trust-building engagement activities on the village level played a central role in this process; the initiative became accordingly referred to as Community Network Engagement for Essential Healthcare and COVID-19 Responses Through Trust (CONNECT)—and motivated the present research. The roll-out of CONNECT commenced in December 2021 (and was still ongoing at the time of manuscript submission), targeting high priority ‘focus’ districts and villages nation-wide. The foundational research reported in this manuscript, therefore, constituted a critical form of public involvement in the design and implementation of the CONNECT initiative. As we further indicate in the Results sections, we elicited and received positive participant feedback about the data collection process and research instrument.

Research sites

The study setting of rural Lao PDR represents a lower middle income country context with rapid development progress yet persistent healthcare challenges and inequalities. 27 Official poverty headcount rates (at US$2.15/day in purchasing power parity) declined from 25.4% in 2002 to 7.1% in 2018, and between 2000 and 2020, life expectancy increased from 58 to 68 years and rural electrification from 27.4% to 100%. 27 Despite this progress, public health expenditure has remained at a comparatively low 1.2% of gross domestic product, and its 42.9% share of total health expenditure hardly exceeded the 41.8% accounted for by out-of-pocket expenses in 2020. 27 Lao PDR is also still dependent on health aid, which accounted for 15.4% of total health expenditure in 2020. 27 In addition, 63.1% of the country’s 7.4 m population live scattered across the vast rural areas (Lao PDR is the most sparsely populated country in Southeast Asia and the seventh in all Asia), which make infrastructure and healthcare provision challenging. 28 For example, safely managed drinking water access remains at a low 12.4% in 2020 while latest available data from 2017 indicate that only 67.0% of births in rural areas were registered. 27 Rural healthcare provision, therefore, remains challenging, even if recent advances in National Health Insurance provision as de facto universal health coverage scheme have lowered the costs of accessing health services to a nominal copayment of LAK 5000 (US$ 0.30).

The specific study sites were the provinces of Bokeo, Xaisomboun, Khammouane and Champassak ( figure 1 ). Latest poverty measurement data by Coulombe et al. 29 from the year 2015 indicated that Bokeo had a poverty headcount ratio of 25.5% and an adult literacy rate of 67.0%, with corresponding values in Xaisomboun of 27.8% and 74.4%, in Khammouane of 27.1% and 83.5% and in Champassak of 22.8% and 91.2%. While Bokeo Province was also the site for the preliminary research, all provinces together represented a selection of geographically, economically and ethnically diverse settings.

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Map of Lao PDR and study sites. Source: Adapted from Wikimedia Commons ( https://commons.wikimedia.org ; file: Laos provinces.svg. user: Infernoapple). Study provinces highlighted in red; Bokeo province was also site for the preliminary qualitative research.

Research design

Our research team implemented a sequential mixed-method research design to study the local expressions and patterns of trust in rural Lao PDR ( figure 2 ). Phase 1 aligned with the CONNECT Initiative and involved exploratory qualitative research that aimed at generating evidence to improve community engagement, to increase uptake of essential maternal and child healthcare services and to develop community-led COVID-19 responses. The second phase translated the qualitative findings into a survey questionnaire with a dedicated module on trust and involved a parallel qualitative–quantitative design: phase 2a tested the survey instrument through cognitive and contextualising expert interviews, and phase 2b piloted and implemented the survey questionnaire.

Mixed-method research design including timeline and data collection tools. Source: Authors. Grey-shaded elements were part of the larger preliminary research for the CONNECT Initiative but did not inform the research objective on trust. CONNECT, Community Network Engagement for Essential Healthcare and COVID-19 Responses Through Trust.

Data collection

Data collection during phase 1 took place in February 2021 in Bokeo Province. Among the broader range of open-ended qualitative data collection methods during this phase, 30 those that enabled a specific insight into the issue of trust from community members’ perspectives were 30–60 min semistructured interviews and 90 min focus group discussions with villagers. The interviews and focus group discussions were convened by trained master’s students and staff from the Lao Tropical and Public Health Institute (Lao TPHI) with support from the University of Health Sciences (UHS), Mother and Child Health Centre and WHO in Lao PDR. Each interview and discussion session was audio recorded with prior informed consent. In the focus groups, one investigator led the session through a series of open-ended questions and prompts while other investigators noted key points and observations, which were subsequently synthesised through daily discussions among the team in the field to draw out common themes.

The open-ended approach (summarised here to avoid redundancies and to retain brevity of the overall manuscript) indicated that key reasons for poor trust in health providers included: being charged extra fees or being told to buy medicines privately; nobody available at health facility or no medicines/equipment; own or peers’ bad experiences; healthcare staff speaking impolitely, not paying attention, or having difficulties in communicating needs; not having any previous contact/connection with health staff; difficulties with understanding or using health insurance, lack of willingness by health staff to be flexible about documentation; health staff from a different gender/ethnic group, fear of discrimination or embarrassment. These initial insights formed the basis for a preliminary survey questionnaire module on community trust in primary healthcare services. The process was supported by the grounded inputs from the Lao research teams (who specialised in community development) and the expert review by Lao health systems and maternal and child health experts as well as medical anthropologists within our team.

Phase 2 took place from October 2022 to April 2023 and involved the piloting and implementation of the tablet-based and interviewer-administered 40 min survey questionnaire and its 10 min module on community trust in their local health centres. The pilot took place in Champassak Province and was followed by a further round of expert review, which entailed refinement of the question focus (eg, considering that payments and gifts may be voluntary to express gratitude), the range of indicators (ie, removing systems trust) and the answer categories (eg, capturing indifference in yes/no answer options). Both the pilot and implementation stage were accompanied by 20–30 min cognitive interviews to help develop the questionnaire and interpret its data (we used an open-ended variant of cognitive interviews that resembled more natural semistructured conversations on the individual survey items and thereby accommodated the interaction dynamics more respectfully in the local context than the structured ‘think aloud’ process of the original cognitive interview conceived in Western contexts), and 30–45 min expert interviews with community members, village authorities and health centre staff plus non-participant observations of community life to provider broader community context for survey data interpretation. 31 The data were collected by a seven-member Lao survey team experienced in community development, who gathered responses in Lao or in the preferred ethnic languages of the respondents (for which we recruited local translators). The data collection instruments are available in online supplemental material .

Supplemental material

Fieldwork for phase 1 was conducted in two districts of Bokeo province. In each district, the research team purposively selected two health centres based on variation in healthcare service uptake (informed by administrative data), and two villages in their catchment areas with varying sociodemographic characteristics (ethnicity, livelihoods, income). Across these four health centres and eight villages, 25 people participated in the semistructured interviews, including 11 pregnant women and 14 village health committee members (all aged between 18 and 55 years). A further 120 people joined 17 focus group discussions with five to eight homogenous participants each, covering six groups with pregnant women, six groups with husbands and five groups with senior villagers aged above 60 years. The participants had Hmong, Khmu, Lue, Lamed and lowland Lao ethnicity. 30

Data collection in phase 2 took place in three-stage survey design with non-probabilistic sampling. In the first stage, this involved four purposively selected provinces to represent diverse social, economic and healthcare settings across Lao PDR and following loosely the gradual roll-out of the CONNECT Initiative. Following the CONNECT objectives of reaching marginalised communities who experienced challenges in maternal and child healthcare uptake, the second stage involved the purposive selection of 14 CONNECT target villages as study sites, which were selected with variable levels of primary healthcare service uptake (prioritising low-uptake settings), remoteness, village size and ethnic diversity. Within the study communities, the third stage (representing study phase 2b) involved a complete census of all villagers (inclusion criteria: aged 16 and above, ordinary resident of the selected community). In the absence of comprehensive village registers prior to the data collection, we established sampling frames from publicly available satellite imagery to identify, list and approach all residential structures in a community, and update them dynamically during the data collection process where satellite images did not yet include newly built houses. 32 The resulting survey samples, thus, reflected a snapshot of the daytime resident population in the study communities with between 43 and 318 responses per village (131 on average) and 1838 responses in total ( table 1 ; refusal rates were below 5% on average). Complementary qualitative research took place alongside the survey (phase 2a) and involved a purposive selection of cognitive interview participants and expert informants based on their healthcare experiences, gender and their reported experiences of trust during the quantitative survey. The expert interviews involved village authorities and healthcare staff. The ensuing 26 cognitive interviews and 17 expert interviews included 31 villagers and village authorities, of whom 45.2% were women with ethnic groups spanning Hmong, Khmu, Lamed, Phu Thai, Jalee and lowland Lao. Online supplemental material table A1 provides further summary statistics on the demographic attributes of the sample.

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Summary of qualitative and quantitative samples

Phase I qualitative data were transcribed into Lao and analysed by the Lao-speaking members of our research team (led by Lao TPHI, UHS, and WHO). For phase II, we transcribed and digitised all qualitative material and maintained bilingual Lao and English versions, which our broader study team analysed bilingually. 31 Analysis was carried out using spreadsheets and MAXQDA 2020 33 and following content-oriented thematic analysis. In phase I, this analysis process was inductive and involved identifying and coding any trust-related content of the data and subsequently categorising it into patterns or themes related to the various components of trust, so as to arrive at a comprehensive understanding of the varied dimensions of trust in primary healthcare services. The qualitative thematic analysis process in phase II was instead deductive as it focused on the initially established themes in order to identify their expressions and relevance as well as to triangulate the phase I findings. In this process of data triangulation across phases, the diversity of respondents and settings helped to actively source negative cases to challenge—and more clearly delineate—the categories within the evolving structure of the multidimensional trust concept. With view towards conciseness, the presentation of the qualitative findings in this manuscript will thereby foreground the responses to the cognitive interviews as they provide direct reactions to the preliminary trust dimensions developed during Phase 1 (on the basis of broader, open-ended qualitative data).

The subsequent quantitative analysis aimed at presenting the (a) resulting patterns, (b) socioeconomic correlates and (c) behavioural consequences of trust in rural Lao PDR. To describe the levels and patterns of trust and its component dimensions, we used non-inferential descriptive statistical analysis given that the community census data already represented the daytime adult population in the 14 case study communities. 34 The descriptive analysis in step (a) thereby served as an additional layer of method triangulation to establish the prevalence and emerging patterns of trust among our diverse study sites in Lao PDR. Steps (b) and (c) used multivariate regression analysis, 34 namely: linear regression models to understand the predictors of the trust index (using common socio-economic indicators such as gender, education, wealth, ethnicity and village location), and logistic regression models to understand the contribution of trust to health centre access during acute illnesses (focusing on illness episodes reported by adults and for children under their supervision) and during pregnancies (reported by currently and recently pregnant women). The regression models in step (c) both controlled for standard socioeconomic indicators; healthcare access during acute illnesses further controlled for illness severity and whether the patient was an adult or child. Although the pilot phase entailed slight modifications to the original survey instrument, the trust indices in the pilot and full-implementation provinces were highly correlated and we, therefore, present provincial-level disaggregated statistics from all four provinces in this paper.

Ethical considerations

Prior informed consent was obtained from all study participants. The data collection in both phases was integrated into government structures: public health authorities facilitated village access and data collection; operational insights from each survey mission were fed back to village and health authorities; and survey findings were shared with provincial and central government authorities (including MoH and MoHA).

Qualitative exploration

Relevance of trust.

Before exploring what trust means concretely, it is helpful to establish its relevance in the rural Lao context. The qualitative findings suggested that it did: participants were generally comfortable talking about trust, using the typical words (or ethnic language equivalents) for the literal Lao translations of ‘trust’ (ຄວາມໄວ້ເນື້ອເຊື່ອໃຈ or khuam vai nuea suea jai ) and ‘confidence’ (ຄວາມໝັ້ນໃຈ or khuam mun jai ). As a widely understood concept, participants underlined that ‘ trust is important’ (man, 42, lowland Lao, Khammouane Province, cognitive interview) and were easily able to explicate their trust in primary healthcare services, explaining, for instance, that they had ‘ about 70%’ confidence in their local health centres (man, 48, Hmong, Xaisomboun Province; cognitive interview). Even if the issue of trust was not being probed explicitly, it arose naturally during conversations and observations.

The subject of trust also appeared to have often real implications for the treatment-seeking behaviour of patients and caregivers as villagers would in low-trust situations ‘ skip the health centre’ (woman, 26, lowland Lao, Champassak Province, cognitive interview) and ‘ better go directly to the district hospital’ (man, 37, Phu Thai, Khammouane Province, cognitive interview). Trust was, therefore, a pervasive and relevant concept in local treatment-seeking practices.

Defining trust

Participants were able to articulate personal definitions of trust, for instance, relating to health centre staff doing a very good job’ so that the patients will get better very fast (man, 42 and 37, lowland Lao, Khammouane Province) and in recognition of the efforts and intrinsic motivation of healthcare workers to use of their ability to help people (man, 52, Khmu, Bokeo Province; similar statements were also encountered among Khmu and Hmong respondents in Xaisomboun Province). Ethnic minority groups further stressed in their definitions of trust the direct interactions with healthcare staff, such as in the case of a 24-year-old woman Lamed villager: the doctors do not pay close attention to us. I think just because I am not the head of the village or someone that important, they do not treat us well .

However, trust was not explicitly recognised among every villager. Especially female respondents would reiterate that they cannot explain the idea of ‘trust’ and that It’s just that I don’t understand it’ (woman, 21, lowland Lao, Khammouane Province; woman, 27, Khmu, Bokeo Province; woman, 25, Hmong, Xaisomboun Province). Trust does also not automatically supersede other pragmatic considerations of healthcare utilisation such as mere availability of facilities and medical supplies. A 64-year-old lowland Lao man in Champassak Province would share in this context that he absolutely trusts the local health centre, but if something happened here, we are likely to go to the 103 Hospital (a local military hospital) , which is closer to us than the health centre .

Overall, this wide range of definitions suggests that externally assigned definitions of trust run the risk of misrepresenting local populations’ priorities. A systematic consideration of the components of this concept is, therefore, beneficial to create locally relevant forms of measurement.

Trust components in rural Lao PDR

The qualitative analysis yielded eight themes representing subcategories of trust in primary healthcare services in rural Lao PDR across the three main types of trust—interpersonal, institutional and service-related trust (represented through the coding framework in figure 3 ), which formed the basis for the subsequent development of quantitative survey indicators to measure trust at scale.

Coding framework representing categories of trust as core themes, with explanation and example quotes. Source: Authors, derived from qualitative research fieldwork.

The first theme was communication as a form of interpersonal trust, with impolite, inattentive or difficult interactions indicating diminished trust in the provider. Villagers were generally ready to articulate their opinions about communication experiences. While experiences sometimes involved nuanced statements or even explicit praise (eg, They were polite and explain the symptoms, treatment, and recommendation;’ man, 47, Jalee, Khammouane Province, cognitive interview), it was mainly the negative communication experiences that participants related directly to their trust in healthcare staff. One of several examples involved a respondent in Champassak province, who recalled situations where staff were on their phones, keep us waiting, and […] did not give any advice (man, 29, lowland Lao, Champassak Province, cognitive interview). Also language barriers would provoke experiences of abrasive interactions and poor treatment—as especially female members of ethnic communities reported repeatedly.

A second and related component of trust was the concrete treatment experience, represented through respectful care (ie, interpersonal trust, owing to the emphasis on ‘respect’). Common experiences of disrespect arose during maternal and child care at the health centres. In one such case, a woman bringing her feverish child to the health centre found only male staff who ‘ did not really care, just do everything very quickly’ (woman, 26, lowland Lao, Champassak Province, cognitive interview). Likewise, a mother delivering her baby at the health centre recalled how staff ‘ did not do anything. They just cut the umbilical cord, but did not clean the baby, and then they gave the baby to my mother-in-law’ , during which process she was left exposed as the staff ‘ did not cover up anything for me’ (woman, 24, Lamed, Bokeo Province, cognitive interview). Treatment experiences, therefore, often related negatively to trust; that is, they were disrespectful.

A third component of trust was the nature of the personal relationships between community members and health centres (interpersonal trust). Existing connections, a shared community identity, or outreach activities would create familiarity and enable comfortable interactions (thus closely relating to the two aforementioned dimensions). Such relationships were typically expressed in positive terms like, Every time I go to the health centre, I can talk comfortably to the staff (man, 37, lowland Lao, Khammouane Province, cognitive interview; note that this is a typical Lao expression to describe a familiar relationship) ‘ They are like relatives’ (man, 53, lowland Lao, Champassak Province, cognitive interview). Positive relationships were also forged through health centre outreach activities, for example, to administer medicine and food supplements for children or to donate clothes (man, 47, Jalee, Khammouane Province, cognitive interview).

The fourth theme was fairness (interpersonal trust), which often followed as practical consequence from the relationships between health centres and communities. Expert interviews with village authorities and health centre staff would normally stress that all people were treated equally (eg, health centre director, Bokeo Province; village chief, Bokeo Province), but villagers’ views were more diverse (although some villagers agreed). Villagers in Champassak Province described for example how kinship ties with healthcare staff enabled preferential treatment, Bokeo villagers reported that health centres provide systematically better care for those villages where their staff live, and experiences of wealth-based and ethnic discrimination arose across the provinces. During our community visits in Bokeo, a villager shared, for instance, how she saw health centre staff neglecting poorly dressed patients, while another villager from a Lamed community experienced that the health centre staff discriminate against people from this village because they were not like Thai Lue (like the health centre staff) or lowland Lao (woman, 24, Lamed, Bokeo Province, cognitive interview).

The fifth component of trust was integrity (interpersonal trust), which related to a supportive healthcare environment in which providers behave transparently and without taking advantage of patients. Aside from perceptions of honesty and support through the care experience at the health centre (eg, with documentation), the key manifestation of integrity was whether healthcare workers explicitly demanded or implicitly valued payments beyond the official costs of healthcare provision—directly in cash or by requestion patients to buy out-of-stock medicines privately at the houses of health centre staff. This issue was most salient in the interviews in Khammouane and Bokeo Provinces, and preliminary research participants in Bokeo Province would repeatedly stress this problem:

When I go to the health centre, the staff asks me the question, ‘Did you bring a lot of money or not?’ If I have money, they would treat me, but if I don’t have money, they would tell me to go to another hospital (pregnant woman, Bokeo Province, preliminary focus group discussion).

Taking a broader institutional perspective, the sixth component of trust was the reputation of the healthcare provider . Indeed only few villagers ‘ never heard any (stories)’ (man, 53, lowland Lao, Champassak Province); rumours and narratives were pervasive in all communities. A typical kind of story would relate to treatment failure: A Champassak villager shared that her friends delivered a baby at her local health centre, but she lost too much blood and got transferred to the state hospital and eventually did not survive. Such and other outcomes like the death of a child would lead villagers to no longer trust the local health centre (woman, 26, lowland Lao, Champassak Province, cognitive interview). Elsewhere rumours spread that healthcare staff were illegally charging LAK 50 000 (approximately US$2.50) per COVID vaccine injection after claiming that they were out of stock. Rumours and stories thus typically undermined health providers’ reputation, and only rarely involved positive reports and recommendations.

The remaining two components both reflected service-related trust, the first of which was the assurance of treatment . This component reflected patients’ ability to receive care when they want or need it. Staffing, availability of medicines and also acceptance or refusal of patient requests would shape how community members trusted their health centres. A pregnant woman during a preliminary focus group discussion in Bokeo province illustrated this problem vividly through the case of a fellow villager:

A pregnant woman visited the health centre and did not see any staff there. Then she looked for them at the back of the health office, but the staff got upset and shouted at the woman, saying that, ‘At your age, you already had experience of pregnancy. So why do you come here?’ That is why we do not like going to the health centre except when we have a severe illness, otherwise we do not go. Even if we go there, we get nothing from them . (Pregnant woman, Bokeo Province, preliminary focus group discussion)

Such examples of trust-impacting assurance of treatment were common, and also included cases such as absent health centre staff who were instead found drinking beer (Champassak Province) or long queues and delays in getting access during emergencies (Bokeo Province).

The final service-related dimension of trust pertained to the perceived competence of the health centre staff. Healthcare staff skills featured prominently in community members’ narratives, whereas questions surrounding the assurance of treatment were often answered in negative terms, perceptions about staff competence where typically more balanced, with positive impressions often underlined by patients’ willingness to voluntarily offer additional compensation to staff: They never asked (for money). But we offer them (money) as a gift. They take good care of us, so we voluntarily give it to them . […] If we don’t give them money, they would still take good care of us (man, 44, Hmong, Xaisomboun Province, cognitive interview).

In addition to these eight dimensions, the literature and the preliminary research phase would also highlight ‘systems trust’ as an important institutional component of trust that goes beyond the direct relationship between community members and health centres. Systems trust offers a useful perspective that could complement the existing institutional theme of ‘reputation’ in our qualitative research. However, systems trust as a broader belief in institutions, processes and policies of the health system (eg, the government’s ability to establish a functional referral system, see Straten et al 35 ) often remained an abstract idea for villagers or would otherwise materialise in expressions that were orthogonally related to trust in primary health services. Villagers would, for instance, describe that needing to access a health centre first to get a referral to a district hospital would be an inconvenience (woman, 26, lowland Lao, Champassak Province, cognitive interview) as they would go there just to waste time and money for fuel (man, 37, Phu Thai, Khammouane Province, cognitive interview)—rather than expressing their trust in the dependence and reliability of these referral systems. As our study focused specifically on trust in primary healthcare services, and as health centres’ community-level reputation reflected on institutional aspects of trust to a limited extent, a separate assessment of systems trust in broader health services may, therefore, be better suited as an alone-standing and complementary concept rather than an integrative component of trust in primary healthcare.

In summary, the main qualitative themes reflecting on the components of trust did not only underline that the concept requires local grounding to enable meaningful conversations and analysis and also that different socioeconomic strata were likely to experience trust fundamentally differently. The following quantitative component in our mixed-method study describes the systematic patterns of trust in and across the rural communities.

Survey results

Instrument construction, testing and validation.

Following the questionnaire development, testing and piloting process, we arrived at an agglomerative trust index that translated the eight components of trust into concrete indicators and questionnaire items—summarised in figure 4 . The interconnectedness of these components in people’s lived experiences meant that some indicators could speak to more than one dimension. For instance, refusal of treatment would reflect on treatment assurance, but respondents would also mention that the experience of refusal reflected on their sense of fairness and that the reasons for refusal hinted at the personal relationship between villagers and health centre staff.

Translation of trust dimensions into measurable indicators in survey questionnaire. Source: Authors, derived from qualitative research fieldwork. Variously positively and negatively worded questions to avoid affirmation bias. Binary response options (yes/no plus ‘don’t know’) coded such that positive indications of trust (eg, a ‘no’ response to a negatively worded question) would positively contribute to the trust 8-item trust scale.

The cognitive interviews demonstrated that the indicators reflected relevant dimensions of trust, and that respondents were able to answer the survey questions confidently. Villagers would commonly comment that they were happy to express and share my experiences (woman, 21, lowland Lao, Khammouane Province, cognitive interview) and that the survey questions were easy to answer (man, 34, lowland Lao, Champassak Province, cognitive interview) given that those are the problems that we face every day (man, 30, Lamed, Bokeo Province, cognitive interview). Perhaps yet more importantly, the respondents also repeatedly stressed the more fundamental value of gathering information about trust from them. For example, a female villager in Champassak Province commented that our survey team were the first group of people I shared [feedback about the health centre] with and that she hope [d that] it will create some impact (woman, 26, lowland Lao, Champassak Province, cognitive interview). Another villager would explain that, We do want to share our opinion [about the health centre] but it’s quite hard. And luckily we have your project come to our village. Therefore, I am very proud and grateful to share ,’ hoping in light of their remote location that the survey would help the health centre develop (Male, 30, Lamed, Bokeo Province, cognitive interview; note that survey insights were shared accordingly with authorities on the village, district, provincial, and central levels). (While this also suggests that reticence among the respondents was limited, among the mechanisms to elicit an open response from the participants were the use of open-ended questions to avoid social desirability biases (eg, ‘Can you give me an example of the kind of stories you heard about the health centre or its staff?’) and alterations of positively and negatively worded binary response questions (eg, ‘Can you talk comfortably with the staff at the health centre?’ vs ‘Is the health centre a place where staff treat you badly?’) to limit affirmation bias among potentially reticent respondents.)

Statistical findings

In this final Results section, we describe the patterns and distribution of trust across and within the 14 Lao case study communities. Table 2 begins with showing the trust index, whereby each component was normalised into a value range from (−1 to +1). Adding all eight components, the overarching index ranged accordingly from −8 to +8).

Distribution of trust index dimensions across Lao provinces

The top part of table 2 demonstrates that most indicators were on average positive (except tonality in Champassak), meaning that respondents would typically express trust rather than distrust. We can also observe a high degree of variability across the components (see ‘average’ column): The tonality of health centre stories (representing institutional trust through the community-level reputation of primary healthcare services) was the least trusting expression, followed by the perceived competence in provider skills as a form of service-related trust. In contrast, experiences of treatment refusal were relatively uncommon. Other trust dimensions with particularly low expressions were the experience of poor treatment in Champassak and Xaisomboun Provinces, common informal payments and gifts to healthcare providers in Bokeo Province, or the perceived skill level of health centre staff in Khammouane Province. The largest differences across the provinces included the presumed readiness of health centres to cater to accidents (Assurance of care), experiences of discrimination (Integrity), and treatment refusal (Relationship/Fairness/Assurance of care). Experiences of ethnic discrimination as an expression of interpersonal trust were surprisingly uncommon compared with the qualitative data: while 7.9% (142/1797) of the sample reported instances of discrimination, only 8.1% (7/87) of the 87 explicit explanations about these situations related to ethnicity, whereas with 37.1% (30/87) most cases related to economic discrimination (based on wealth and poverty).

The eight components formed a composite trust index whose values ranged from 4.19 in Champassak Province to 4.85 in Xaisomboun Province. This composite index enabled a more nuanced and insightful understanding of trust than an overarching one-dimensional indicator (ie, whether people ‘rather trust’ or ‘rather distrust’ the health centre; see bottom part of table 2 ), which only had moderately positive correlation coefficient of +0.44 with the trust index. Table 2 also provides an alternative measure of ‘trust,’ based on the number of times that health centres were mentioned as recommended resorts to care for (a) antenatal care, (b) place of delivery, (c) injury treatment and (d) COVID-19 care. Ranging from (0 to +4), this alternative index exhibited its lowest value of 1.03 for Champassak Province and its highest value of 3.25 in Bokeo Province, while being only mildly positively correlated with the eight-item trust index (correlation coefficient: +0.29). These scores highlight the limitations of this alternative measure: In Champassak, many case study communities were located near better-equipped hospitals that made a visit to the health centre unnecessary, whereas in Bokeo Province, many of the communities were located far away from other healthcare facilities, which made it most plausible to recommend fellow villagers to seek care at the available health centre irrespective of how much one trusts them. The eight-item index is thus a more informative assessment of active dis-/trust in local health centres; an index based on recommendations for resorts to care would instead conflate trust with pragmatic considerations of access and availability.

The socioeconomic correlates of trust were largely indistinctive. Although the SD of the index ranged within each village from 1.88 to 3.12 (with an index value range as wide as 13 index points, that is, from (−5 to +8)), neither gender, education, wealth, age, ethnic group, mother tongue or religion exhibited a noteworthy bivariate or multivariate relationship with the trust index (not shown here; see online supplemental material table A2 ). The trust index varied systematically across the case study communities, among which average index scores ranged from 3.83 to 5.65. A multivariate linear regression model would indicate that 7 out of 14 village identifiers had a statistically significant association with the trust index (at the 5% level). This suggests that communities tended to share relatively homogenous experiences with their local health centres, and that health centre operations tended to be more decisive in shaping local expressions of trust.

In a final step, we estimated multivariate logistic regression models that assessed the relationship between health centre utilisation of patients and pregnant women, trust and other common explanatory variables such as gender, education and household wealth. Table 3 summarises the main findings of this analysis and shows that the trust index did not exhibit a statistically significant association with health centre access during acute illness episodes, and only a mildly positive association at the ten-percent-level emerged for women seeking antenatal care during a current or recent pregnancy. While the coefficient estimates were only mildly sensitive to the inclusion of village dummy variables, overall model fitness for the smaller sample models of antenatal care was affected by their inclusion (as the removal of perfect predictors would reduce the effective sample size).

Regression results

Robustness checks using the alternative, recommendation-based index (models 3, 4, 7 and 8) exhibited a consistently positive and statistically significant association (at the 1% level). In light of the aforementioned discussion, the analysis did not discern a statistically significant relationship between trust and health centre access during acute illness episodes, whereas availability of facilities appeared to be a more decisive predictor. However, in the case of pregnancy care, trust was weakly associated with health centre utilisation (as far as the small subsamples and the cross-sectional study design allows us to infer). For example, a 1 SD increase from the mean value of the recommendation index would be associated with a 20.6% percentage-point higher predicted rate of health centre utilisation; 1 SD changes from the mean index values for recently/currently pregnant women would be associated with a 4.9% higher predicted health centre utilisation rate for the trust index and a 10.9% higher predicted rate for the recommendation index. Figure 5 summarises these relationships graphically.

Predicted relationship between trust and health centre access Source: Authors. Predictions within index value ranges of respective sub-samples. Panels a1, a2, b1 and b2 based on Models 2, 4, 6 8 in table 2 , respectively. The estimated relationship between trust index and health centre access in Panel a1 is not statistically significant.

Our qualitative research established that issues of trust were pervasive in villagers’ narratives surrounding healthcare experiences on the primary care level. Villagers were ready to articulate what trust means, and our qualitative analysis identified eight themes representing important components of trust: communication, respectful care, relationship, fairness, integrity (all as expressions of interpersonal trust), reputation (institutional trust), assurance of treatment and competence (service-related trust). We translated these components into standardised survey items to trace the expressions of trust within and across 14 Lao communities in four provinces. Cognitive interviews attested that the survey instrument resonated with local notions of trust that were important from the perspective of the rural populations. The trust index thus enabled us to compare the expressions of trust in different regions of Lao PDR, whereby individual differences appeared less pronounced than variations across health centres that cater to the communities (similar to findings in Helfinstein et al. 36 ). Analysing the relationship between trust and health centre utilisation further suggested that different levels of trust were weakly linked to pregnant women’s antenatal care choices, and robustness checks indicated that availability of healthcare providers (gauged through villagers’ recommendations for care outlets) may be a more decisive predictor of health centre access.

In comparison to studies from high-income contexts (eg, 12 ), our research underlined the persistent importance of interpersonal, institutional (esp. health provider reputation) and service-related types of trust between community members and primary healthcare providers, 8 9 whereby individual dimensions of ‘confidentiality’ or ‘systems trust’ did not materialise as salient themes. Our work also provides methodological guidance on the translation from the qualitative identification of trust dimensions to their standardised assessment in a grounded and locally relevant survey instrument. In relation to the Lao research landscape in particular, our study did not detect a strong association between trust and healthcare utilisation 19 20 but it echoed widespread concerns about informal payments 21 and the importance of respectful care in the context of maternal and child healthcare services. 22–24

However, further research will benefit from exploring expressions of trust across low and middle-income countries more broadly to arrive at an authoritative and grounded framework of trust to guide global health policy. Future research would also benefit from studies of trust in other informal as well as formal elements of the health system (such as traditional healers) and how health and development interventions alter this landscape with potentially unintended consequences. 37–39

In the case of Lao PDR, our index suggested that priority areas to improve community trust in primary care services were service-related areas of provider skills and their tools, and interpersonal aspects of trust relating to practices of respectful care and the pervasive requirement of informal payments. The reputation of health centres was a key institutional element as well, whereby activities to boost the image of local health centres could include quality assurance initiatives for health centre staff communication (eg, through supportive supervision approaches) and relationship-building community outreach activities. The data analysis further suggested that the availability of healthcare providers may be more decisive in acute care situation as well as for antenatal care uptake. However, trust appears to be a factor for antenatal care access (where elements of individual choice may be more strongly emphasised than in acute care situations, see, eg, Phommachanh et al 22 ), which policy action could address potentially more economically as a first step.

Trust matters in global health, but the development of the concept has lagged behind its rhetorical use in policy and research. Our study aimed to contribute to this development from a rare lower middle-income country perspective. As we demonstrated that trust in rural Lao PDR was intrinsically valued and relatively important for antenatal healthcare access among pregnant women, we add to the conceptual, methodological and empirical knowledge of a topic with ever-growing importance in global health policy and research. The practical consequence of our work is that supply-sided aspects of frontline health system development remain important but relational dimensions in health system development expressed in interpersonal, institutional and service-related trust also require explicit recognition and integration into health policies and initiatives, 40 41 which can practically be supported by elevating the status of community engagement as a positive (ie, non-blaming) tool to foster trust and forge relationships between the general population and health service providers. 26 40 42 In addition, trust-building interventions may not yield impact if they fail to address locally important dimensions that require improvement. As a result, top-down approaches to community engagement are likely to fail and require instead substantial groundwork with target populations to identify key dimensions and issues in their trust towards health services. 26 43

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Ethical approval was obtained from the Lao National Ethics Committee for Health Research (NECHR; ref. 084/NECHR and 069/NECHR) and the WHO WPRO Ethics Review Committee (ref. 2020.13.LAO.1.MCN). Participants gave informed consent to participate in the study before taking part.

Acknowledgments

We would like to gratefully acknowledge the research partners OCC, WPRO, WHO country office; all stakeholders at provincial, district and all target communities and the member organisations of this research network for their assistance with this work. Thanks to all Lao TPHI staff and master student's promotion 20 and 21, staff at UHS, MCHC for the fieldworks data collection. We also acknowledge gratefully the extensive data collection efforts of Ounkham Souksavanh and the CONNECT Community Engagement team, the survey team including Thongkhoon Xayyahong, Latthanikone Sabphaisan, Maynika Phongsa, Antyka Xayaphone, Thinakone Louangdy, Keomano Luangkhot; specialist survey training provided by Nutcha Charoenboon; and administrative assistance from Toulavanh Xayphone.

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

Handling editor Seye Abimbola

X @HaenssgenJ

Contributors MJH (guarantor): concept, proposal including methodology, overall supervision, data collection, overall data analysis and write-up. EE: concept, proposal including methodology, supervision, contribution to data collection, data analysis and edit. SPhomm, SPhomk, SKo: contribution to methodology, contribution to data analysis and edit. SKu: concept, contribution to methodology, contribution to data analysis, obtained ethical approval, funding acquisition, supervision and edit.

Funding The research was funded by the World Health Organization Regional Office # 202634961.

Disclaimer The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization.

Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

Competing interests None declared.

Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

Provenance and peer review Not commissioned; externally peer-reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Data Visulization Techniques for Qualitative Research

Data visualization techniques play a crucial role in qualitative research by helping researchers explore and communicate patterns, relationships, and insights within their data. Here are some effective techniques commonly used in qualitative research. Qualitative data, conveyed through narratives, descriptions, and quotations, differs significantly from quantitative numerical data, necessitating distinct display strategies. The richness of qualitative data lies in its contextual nuances, which must be preserved in visual representations to accurately reflect underlying meanings and relationships. However, this depth of information poses a challenge in maintaining clarity and insightfulness in visualizations. Unlike standardized quantitative data, qualitative data is unstructured and varied, making it challenging to produce consistent and informative visual representations. To fully comprehend complex events, qualitative research employs an exploratory and interpretive methodology.

In this post, we will look into some Data Visualization Techniques to present Qualitative data.

Table of Content

Different Types of Techniques for Visualizing Qualitative Data

1. word clouds, 2. text networks, 3. heatmaps, 4. chronology charts, 5. mind maps and concept maps, 6. flow charts, 7. narrative visualizations, importance of data visualization in qualitative research, best practices for visualizing qualitative data, data visualization techniques for qualitative research- faqs.

Qualitative data lends itself especially well to the following visualization techniques:

Word frequency determines the size and prominence of words in a word cloud, which is a visual representation of text data. They provide a brief synopsis of important ideas and terms and may be particularly helpful for huge datasets, such as social media analysis or open-ended survey replies.

• Identifying key themes or topics in qualitative data.
• Visualizing the frequency of words or concepts within a text corpus.
• Highlighting prominent terms in interviews, surveys, or open-ended responses.

• Revealing relationships between words or concepts in textual data.
• They support the identification of connections, overarching themes, and conceptual co-occurrences in the data.
• Text networks are useful for investigating semantic structures and may be used to the creation of theories or the comprehension of intricate connections.

Within a matrix, data values are represented by color changes in heatmaps. They are used in qualitative research to illustrate the prevalence of certain themes or codes among various variables or time periods. Heatmaps provide a concise visual synopsis that facilitates the identification of noteworthy regions or unforeseen outcomes.

• Identifying patterns or clusters in qualitative data.
• Visualizing the intensity or density of themes or concepts across multiple dimensions.
• Highlighting areas of interest or divergence within a dataset.

Chronology charts are a great tool for showing how themes or ideas change over time, particularly in studies that follow a subject across time or when examining how an idea or phenomena develops.

• Illustrating the chronological order of events, actions, or developments.
• Visualizing temporal patterns, trends, or changes over time.
• Analyzing the sequence of activities or decision-making processes.

• Organizing and structuring complex qualitative data into hierarchical frameworks.
• Visualizing relationships between concepts, ideas, or components of a system.
• Brainstorming ideas, exploring connections, and generating new insights.

Flow charts are an effective tool in data visualization approaches for qualitative research. They provide a visual depiction of processes, workflows, and linkages, making complicated information more accessible and understandable. Flow charts assits in depicting phases of the research process, from data collection to analysis.

They are used to map narrative structures, demonstrating how tales or events are related within the data visualizing the sequence of steps or stages in a workflow.

Helpful in clarifying complex systems or pathways in a visual format.

Narrative visualizations are effective data visualization strategies for qualitative research. They blend narrative elements with visual data representation to communicate ideas and conclusions in an engaging and intelligible way. Narrative visualizations lead the audience through the data, offering context, emphasizing key results, and making difficult material more understandable. This strategy is especially useful in qualitative research, where data is often composed of textual material, interviews, and observational notes.

Narrative visualizations enhance understanding by presenting complicated qualitative by:

• Combining text, visuals, and multimedia elements to engage audiences.
• Exploring complex qualitative insights through interactive storytelling.
• Narrative visualizations help to communicate qualitative results to a larger audience, including non-experts.

For several reasons, data visualization is essential in qualitative research:

• Improved Communication : Compared to text alone, visualization is a more effective tool for explaining complicated concepts and connections. Graphs, charts, and diagrams may help make complex relationships easier to understand for a wider range of people, including those with different degrees of subject matter experience.
• Promote Insights : Patterns and trends that would otherwise go undetected in raw qualitative data can be made visible via the use of visual representations of data. With the comprehensive perspective that visualizations provide, researchers may more easily spot relationships, anomalies, and patterns.
• Engage Audiences : Stylish, well-thought-out images have the power to pique the attention of both the general audience and stakeholders. This interaction promotes further investigation and conversation as well as a better comprehension of the study results.
• Memorability : People tend to remember images better than words. The possibility that important ideas will be remembered and maintained by the audience is increased when study results are presented graphically.
• Assist in Decision-Making : By offering a concise summary of the study findings, visual data representations help in well-informed decision-making. For stakeholders and policymakers who must analyze and act upon study findings, this is very helpful.

In order to guarantee the efficient and accurate representation of qualitative data, consider below recommended practices:

• Clarity and Simplicity: To make the message understandable and obvious, aim for simplicity in your visualizations. Refrain from overcomplication, since it might overshadow the main points.
• Preserve Context: Make sure the original data’s richness and context are preserved in the display. Avoid simplifying things too much. Where needed, use more language or notes to help explain.
• Effective Use of Color : While color may improve understanding, too much of it or the wrong kind of color can take away from the content. Use color deliberately and consistently to draw attention to connections or patterns.
• Label and Annotate : To aid viewers in understanding, provide relevant labels, titles, and annotations. Make sure the main points can be understood even in the absence of more explanation and that the visuals are self-explanatory.
• To achieve a unified and polished appearance, keep design components, typefaces, and color schemes consistent throughout visualizations. Maintaining consistency improves the overall visual appeal and facilitates comparisons.
• Investigate Several Representations : Try out several visualization strategies to see which one best suits your data. Instead of depending on just pre-made chart types, think about creating custom visualizations that are suited to your particular dataset.

For qualitative researchers, data visualization is an invaluable tool that helps them make sense of complicated, rich data and detect patterns as well as explain results. Researchers are able to adequately portray and study the intricacies and complexity of human experiences, actions, and views by using suitable approaches, best practices, and developing technology. Data visualization will play a more and more important role in supporting comprehension, teamwork, and powerful narrative as qualitative research develops.

Which data visualization trends are we seeing emerge for qualitative research?

Immersion and interactive visualizations, automated visualization generation, multimodal and multimedia visualizations, collaborative and participatory visualizations, integration with mixed methods research, explainable AI and interpretable visualizations, and the democratization of visualization tools are some of the emerging trends in visualization.

How can academics make sure that data visualization techniques are morally and responsibly done?

Informed permission should be obtained, participant privacy and confidentiality should be given top priority, interpretive integrity should be maintained, biased or misleading visualizations should be avoided, cultural sensitivity should be taken into account, and accessible visualizations should be created.

What abilities are required for qualitative research data visualization that works?

Understanding qualitative research techniques, interpreting and analyzing data, visual communication and design concepts, developing narratives and stories, and being proficient with pertinent visualization tools and technologies are all crucial abilities.

How might intricate qualitative data be made simpler for efficient visualization?

In order to simplify complicated qualitative data, one must concentrate on the most important linkages and insights found in the data. Decide which quotations, themes, or patterns best capture the main idea of your study. Make use of visuals like word clouds, bar charts, or mind maps that provide a clear and succinct summary. To make sure your target audience can comprehend and use the visualization, think about adding further information or comments.

What typical mistakes should one avoid when putting qualitative data into a visual format?

Oversimplification, data distortion or misrepresentation, and context-free presentation are some common mistakes to avoid. Make sure the intricacy and subtleties of the original data are preserved in your representations. Keep ethical issues in mind, particularly those pertaining to participant privacy and informed permission. Furthermore, stay away from using improper or very complicated graphics that might mislead or confuse your viewers. Make your visual representations accurate, simple, and clear.

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Qualitative Research: Semi-structured Expert Interview

• First Online: 23 November 2016

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In Chap. 5 , the motivational factors were ranked according to the relevance observed (Table 5.6 ). In the second phase of this qualitative methodology, the researcher begins with the explanation of different interview types and the justification for choosing semi-structured expert interviews for testing or adding to the factors obtained by PO.

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Translation: the Law of Informational Self-determination.

e.g. “wanna” instead of “want to”

Engl.: “You sit together with your boss and discuss and talk a bit” (23_25).

Engl.: “Yes good, first these things are discussed internally” (02_04).

Engl.: “We know each other quite well” (01_06).

Engl.: “I have experienced cases, when I just went online and started looking. Somewhere […] some community, you can still get some ideas” (23_13).

Engl.: “that one tries to help each other” (02_16).

Engl.: “our boss feel attacked on his professional honor” (14_06).

Engl.: “I think i have the ambition to just wangle some things. I take my time and persist and stay longer. I can go till 7 or 7:30”(23_47).

Engl.: “it must be fun, that is the essential” (03_24).

Engl.: “Interest are very important for me” (21_46).

Engl.: “when you have to motivate yourself” (20_43).

Engl.: “think logical that what I preach to all of them” (20_28).

Engl.: “I don’t expect that everyone knows everything—I have to know where to find it!” (10_14).

Engl.: “Yes, but the communication is very important” (06_14).

Engl.: “don’t ask […] if they do not communicate” (10_31).

Engl.: “that he can decide himself, what makes sense and what not” (02_02).

Engl.: “a good interhuman relationship and a good common basis” (17_45).

Engl.: “that the companionship is correct, as well as the interpersonal atmosphere” (10_33).

Engl.: “boss, because someone has to be there to take a decision” (23_08).

Engl.: “I usually carry a whip, but sometimes I also pet them” (06_38).

Engl.: “then I watch and check how the work proceeds” (03_16).

Engl.: “one relies on the workers, who have expertise” (07_30).

Engl.: “trust should be given, and then it should work out fine” (23_28).

Engl.: “has been in the profession for 30 years” (02_24).

Engl.: “that is because of the experience and the age” (23_37).

Engl.: “and the age pays a role and that are all factors” (03_26).

Engl.: “many things are basic repair knowledge which sometimes is missing” (23_51).

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Finkbeiner, P. (2017). Qualitative Research: Semi-structured Expert Interview. In: Social Media for Knowledge Sharing in Automotive Repair. Springer, Cham. https://doi.org/10.1007/978-3-319-48544-7_6

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