qualitative research methods for education

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Qualitative research for education : an introduction to theory and methods

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• 1.Foundations of Qualitative Research in Education: An Introduction. Characteristics of Qualitative Research. Traditions of Qualitative Research. Theoretical Underpinnings. Ten Common Questions about Qualitative Research. Ethics. What Is to Come. 2.Research Design. Choosing a Study. Case Studies. Multi-Site Studies. Additional Issues Related to Design. Concluding Remarks. 3.Fieldwork. Gaining Access. First Days in the Field. The Participant/Observer Continuum. Doing Fieldwork in Another Culture. Researcher Characteristics and Special Problems with Rapport. Be Discreet. Research in Politically Charged and Conflict-Ridden Settings. Feelings. How Long Should an Observation Session Be? Interviewing. Visual Recording and Fieldwork. Triangulation. Leaving the Field. 4.Qualitative Data. Some Friendly Advice. Fieldnotes. The Process of Writing Fieldnotes. Transcripts from Taped Interviews. Documents Photography. Official Statistics and Other Quantitative Data. Concluding Remarks. 5.Data Analysis. Analysis in the Field. Analysis after Data Collection. The Mechanics of Working with Data. Concluding Remarks.
• 6. Writing It Up. Writing Choices. More Writing Tips. Criteria for Evaluating Writing. Texts. A Final Point about Getting Started. 7.Applied Qualitative Research for Education. Evaluation and Policy Research. Action Research. Practitioner Uses of Qualitative Research. Appendix. Examples of Observational Questions for Educational Settings. References. Index.
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The Oxford Handbook of Qualitative Research (2nd edn)

Patricia Leavy Independent Scholar Kennebunk, ME, USA

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

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Qualitative Research Methods for Science Education

• First Online: 23 November 2011
• pp 1451–1469

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• Frederick Erickson 4  

Part of the book series: Springer International Handbooks of Education ((SIHE,volume 24))

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In this chapter, I describe how high quality research can be done in science education. I include four main sections in which I explain the purposes of qualitative research, data collection, data analysis, and preparation of reports. I emphasize the salience to qualitative research of specifying researchable questions that inevitably change as the research is conducted. I address issues of credibility, ethical conduct, uses of quantitative information, and the necessity to fully understand contradictions.

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Erickson, F. (2012). Qualitative Research Methods for Science Education. In: Fraser, B., Tobin, K., McRobbie, C. (eds) Second International Handbook of Science Education. Springer International Handbooks of Education, vol 24. Springer, Dordrecht. https://doi.org/10.1007/978-1-4020-9041-7_93

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The volumes review the methodological arguments for using qualitative methods, including critiques and rejoinders; place these arguments in appropriate historical and epistemological contexts with respect to the development of qualitative methods in congruent disciplines including anthropology, psychology and sociology; and identify key examples of leading substantive work which illustrate the various issues at stake and the major achievements of qualitative inquiry in education.

Each volume includes an original introduction written by the Harry Torrance, a key figure in the field of education research methods, delineating the theme for the volume and the importance of the contribution of the individual papers and the volume as a whole.   VOLUME ONE: THEORETICAL ORIGINS OF QUALITATIVE RESEARCH METHODS IN EDUCATION   Part A: Theoretical Tributaries from Anthropology, Sociology and Social Psychology Thick Description: Towards an interpretive theory of culture

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Qualitative vs. Quantitative Research: Comparing the Methods and Strategies for Education Research

No matter the field of study, all research can be divided into two distinct methodologies: qualitative and quantitative research. Both methodologies offer education researchers important insights.

Education research assesses problems in policy, practices, and curriculum design, and it helps administrators identify solutions. Researchers can conduct small-scale studies to learn more about topics related to instruction or larger-scale ones to gain insight into school systems and investigate how to improve student outcomes.

Education research often relies on the quantitative methodology. Quantitative research in education provides numerical data that can prove or disprove a theory, and administrators can easily share the number-based results with other schools and districts. And while the research may speak to a relatively small sample size, educators and researchers can scale the results from quantifiable data to predict outcomes in larger student populations and groups.

Qualitative vs. Quantitative Research in Education: Definitions

Although there are many overlaps in the objectives of qualitative and quantitative research in education, researchers must understand the fundamental functions of each methodology in order to design and carry out an impactful research study. In addition, they must understand the differences that set qualitative and quantitative research apart in order to determine which methodology is better suited to specific education research topics.

Generate Hypotheses with Qualitative Research

Qualitative research focuses on thoughts, concepts, or experiences. The data collected often comes in narrative form and concentrates on unearthing insights that can lead to testable hypotheses. Educators use qualitative research in a study’s exploratory stages to uncover patterns or new angles.

Form Strong Conclusions with Quantitative Research

Quantitative research in education and other fields of inquiry is expressed in numbers and measurements. This type of research aims to find data to confirm or test a hypothesis.

Differences in Data Collection Methods

Keeping in mind the main distinction in qualitative vs. quantitative research—gathering descriptive information as opposed to numerical data—it stands to reason that there are different ways to acquire data for each research methodology. While certain approaches do overlap, the way researchers apply these collection techniques depends on their goal.

Interviews, for example, are common in both modes of research. An interview with students that features open-ended questions intended to reveal ideas and beliefs around attendance will provide qualitative data. This data may reveal a problem among students, such as a lack of access to transportation, that schools can help address.

An interview can also include questions posed to receive numerical answers. A case in point: how many days a week do students have trouble getting to school, and of those days, how often is a transportation-related issue the cause? In this example, qualitative and quantitative methodologies can lead to similar conclusions, but the research will differ in intent, design, and form.

Taking a look at behavioral observation, another common method used for both qualitative and quantitative research, qualitative data may consider a variety of factors, such as facial expressions, verbal responses, and body language.

On the other hand, a quantitative approach will create a coding scheme for certain predetermined behaviors and observe these in a quantifiable manner.

Qualitative Research Methods

• Case Studies : Researchers conduct in-depth investigations into an individual, group, event, or community, typically gathering data through observation and interviews.
• Focus Groups : A moderator (or researcher) guides conversation around a specific topic among a group of participants.
• Ethnography : Researchers interact with and observe a specific societal or ethnic group in their real-life environment.
• Interviews : Researchers ask participants questions to learn about their perspectives on a particular subject.

Quantitative Research Methods

• Questionnaires and Surveys : Participants receive a list of questions, either closed-ended or multiple choice, which are directed around a particular topic.
• Experiments : Researchers control and test variables to demonstrate cause-and-effect relationships.
• Observations : Researchers look at quantifiable patterns and behavior.
• Structured Interviews : Using a predetermined structure, researchers ask participants a fixed set of questions to acquire numerical data.

Choosing a Research Strategy

When choosing which research strategy to employ for a project or study, a number of considerations apply. One key piece of information to help determine whether to use a qualitative vs. quantitative research method is which phase of development the study is in.

For example, if a project is in its early stages and requires more research to find a testable hypothesis, qualitative research methods might prove most helpful. On the other hand, if the research team has already established a hypothesis or theory, quantitative research methods will provide data that can validate the theory or refine it for further testing.

It’s also important to understand a project’s research goals. For instance, do researchers aim to produce findings that reveal how to best encourage student engagement in math? Or is the goal to determine how many students are passing geometry? These two scenarios require distinct sets of data, which will determine the best methodology to employ.

In some situations, studies will benefit from a mixed-methods approach. Using the goals in the above example, one set of data could find the percentage of students passing geometry, which would be quantitative. The research team could also lead a focus group with the students achieving success to discuss which techniques and teaching practices they find most helpful, which would produce qualitative data.

Learn How to Put Education Research into Action

Those with an interest in learning how to harness research to develop innovative ideas to improve education systems may want to consider pursuing a doctoral degree. American University’s School of Education online offers a Doctor of Education (EdD) in Education Policy and Leadership that prepares future educators, school administrators, and other education professionals to become leaders who effect positive changes in schools. Courses such as Applied Research Methods I: Enacting Critical Research provides students with the techniques and research skills needed to begin conducting research exploring new ways to enhance education. Learn more about American’ University’s EdD in Education Policy and Leadership .

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Qualitative Research – Methods, Analysis Types and Guide

Table of Contents

Qualitative Research

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

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

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

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

Focus Groups

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

Ethnographic Studies

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

Text Analysis

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

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

Process of Observation

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

Record Keeping

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

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

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

Qualitative Research Analysis Methods

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

Thematic Analysis

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

Content Analysis

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

Discourse Analysis

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

Grounded Theory Analysis

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

Narrative Analysis

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

Phenomenological Analysis

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

Comparative Analysis

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

Applications of Qualitative Research

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

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

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

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

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

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

Purpose of Qualitative Research

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

Qualitative research can serve multiple purposes, including:

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

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

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

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

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

Advantages of Qualitative Research

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

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

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

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

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Journals on Qualitative Research held by UVic Libraries

• International journal of qualitative methods Call Number: ejournal
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UVic Libraries holds many journal titles on research methods, below is a sampling of some relevant titles.  Be sure to do your own catalogue search for additional titles.

• Journal of ethnographic and qualitative research Call Number: ejournal
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Curriculum Making Across Sites of Activity in Upper Secondary School Vocational Education and Training: A Review of the Research in Sweden

Purpose: This paper presents a qualitative systematic review of Swedish research on vocational education and training (VET) at the upper secondary school level over the past 20 years. The review is based on a theoretical model on curriculum making as social practice that may serve as model for comparative studies between countries. By introducing the model, the ambition is to open for new perspectives on VET curriculum in policy and practice. Questions regarding key themes and the interplay of discourses and processes across multiple sites in the education system have not been addressed in previous systematic reviews of Swedish VET research. 

Methods: The methodological approach in the present paper is a qualitative systematic research review with an integrative and interpretative purpose and research design. The qualitative review is based on the conceptual model of curriculum making as social practice, seeking to capture the inherent complexity and porous boundaries of education systems and movements of ideas, discourses and actors between sites of activity. The model is used for mapping the research, and a content analysis for identifying main themes and emphases and exploring and discussing the potential gaps that may inform future international research studies. 

Findings: The results show that the research is focused on the micro and nano sites of curriculum making, with connections to macro site activities of national curriculum policy enactment. Research focusing on the macro site of activity has an emphasis on national policy and policymaking regarding the relationship between academic and vocational knowledge/programmes and apprenticeship and employability. In the micro and nano sites of activity – which comprise the majority of the research – the main themes are vocational knowing and identity, teaching, learning and assessment practices and work-based learning. 

Conclusion: An observation is the absence of principals and middle leaders as actors and informants in the studies. There is little evidence of actors moving between sites of activity and the meso site of activity only comprise a very small part of the research. In this respect, there is a potential gap to be explored, not least regarding how local curricula and syllabi are made and shaped in terms of the influence of representatives from local authorities, companies, trade unions, employer associations, universities and regional agencies. Curriculum making as social practice has the potential to be used for comparative international studies and as a framework that takes national differences in VET education systems into account. 

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Breaking bad news: A mix methods study reporting the need for improving communication skills among doctors in Pakistan

• Muhammad Ahmed Abdullah 1 ,
• Babar Tasneem Shaikh 1 ,
• Kashif Rehman Khan 2 &
• Muhammad Asif Yasin 3  

BMC Health Services Research volume  24 , Article number:  588 ( 2024 ) Cite this article

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Effective skills and training for physicians are essential for communicating difficult or distressing information, also known as breaking bad news (BBN). This study aimed to assess both the capacity and the practices of clinicians in Pakistan regarding BBN.

A cross-sectional study was conducted involving 151 clinicians. Quantitative component used a structured questionnaire, while qualitative data were obtained through in-depth interviews with 13 medical educationists. The responses were analyzed using descriptive statistics and thematic analysis.

While most clinicians acknowledged their responsibility of delivering difficult news, only a small percentage had received formal training in BBN. Areas for improvement include time and interruption management, rapport building, and understanding the patients’ point of view. Prognosis and treatment options were not consistently discussed. Limited importance is given to BBN in medical education.

Training in BBN will lead to improved patient and attendants’ satisfaction, and empathetic support during difficult times.

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Introduction

The duties of physicians extend beyond providing an effective treatment to patients; they also encompass the development of strong communication skills and the establishment of trust with their patients [ 1 ]. This emphasis on communication is crucial as it enables patients to cope with the seriousness and severity of their illnesses, to make informed decisions regarding treatment options, and to manage potential side effects [ 2 ]. In recent years, there has been a shift in medical practice from a doctor-centered approach to a patient-centered one, where patients play a significant role in the decision-making process, ultimately leading to increased patient satisfaction [ 3 ]. However, physicians may find themselves burdened when faced with the task of breaking bad news, fearing the potential reactions of their patients [ 4 , 5 ]. Neglecting to address this challenge can have negative consequences in terms of patient-centered healthcare, as physicians’ reluctance to disclose a bad news may compromise mental and physical well-being of the patients, and at times of the family members too [ 6 ]. On the other hand, physicians are being uncomfortable with their own emotions and do not have enough coping skills to manage their emotions in the moment [ 7 ].

Research studies have documented the lack of training and protocols among doctors for breaking bad news. For instance, a research from Brazil revealed that none of the clinicians at a university hospital were aware of any specific protocol or guidelines for this purpose [ 5 ]. Similarly, in Canada and South Korea, physician training in breaking bad news is reported to be insufficient, and in many underdeveloped countries, it is virtually non-existent despite curricular reforms [ 8 ]. In Northern Portugal, a significant number of family physicians expressed apprehension about breaking bad news and deemed training in this area necessary [ 9 ]. In Iran, inadequate training was identified as the main reason behind physicians’ difficulty and fear in delivering bad news to patients, emphasizing the need for formal training in this domain [ 1 ]. In India, one research documented diverse opinions among oncologists regarding breaking bad news and sharing information with patients, accenting the necessity for physician training in this aspect [ 10 ]. Additionally, a study conducted in Pakistan identified a common reason for increasing violence against healthcare providers as the failure to communicate bad news in a timely and appropriate manner, highlighting the need for better preparation and communication skills during this process [ 4 ]. Several protocols and guidelines have been developed for breaking bad news, with the SPIKES protocol being one of the most widely used due to its comprehensive coverage of essential aspects, particularly the emotional aspect of the process [ 11 ]. This Six-Step Protocol for Delivering Bad News is SPIKES: S for setting up the meeting, P is assessing the patient’s perception, I for achieving the patient’s invitation, K is providing knowledge and information to the patient, E is addressing the patient’s emotions with empathic responses and S for strategy and summary.

Despite the recommendations of the Pakistan Medical and Dental Council to incorporate communication skills into formal medical curricula, and the ongoing discussions regarding medical curricular reforms in Pakistan over the past two decades, little progress has been made in this regard. This lack of action is evident from a recent study conducted in Peshawar, Pakistan [ 12 ]. Thus, the aim of our study was to assess the training as well as the practices of clinicians in Pakistan regarding BBN and provide recommendations for improvement.

Study design

This mixed methods study utilized a cross-sectional design to assess the training and practices of doctors in BBN. The study was conducted at five tertiary care hospitals located in the twin cities of Islamabad and Rawalpindi, namely, Akbar Niazi Teaching Hospital, Benazir Bhutto Hospital, Holy Family Hospital, NESCOM Hospital, and Combined Military Hospital. The data collection period was eight weeks in the first quarter of 2023 to ensure an adequate sample size and data representation. The study participants selected through a simple random sampling included medical personnel directly involved in healthcare delivery within the selected hospitals with a minimum of six months of clinical experience. Medical students and Basic Health Sciences faculty were excluded from the study sample.

Data collection

To collect the necessary data, a 25-item self-administered questionnaire was developed. The questionnaire encompassed two main sections. The first section focused on recording participants’ demographic information, including age, gender, designation, specialty, and years of experience. This section aimed to establish a comprehensive profile of the participating doctors, providing a contextual background for the subsequent analysis of their responses. The second section of the questionnaire delved into the participants’ knowledge and practices related to breaking bad news, drawing from the established SPIKES protocol [ 11 ]. This section comprised a series of questions designed to assess the doctors’ familiarity with the protocol, their adherence to its guidelines, and their overall comfort level in delivering challenging news to patients and their families. The SPIKES protocol, which stands for Setting, Perception, Invitation, Knowledge, Emotions, and Strategy, is a widely recognized framework for effective communication during difficult conversations. Before administering the questionnaire, a pilot study was conducted with ten doctors working in general practice clinics, in Rawalpindi/Islamabad, to ensure its clarity, comprehensibility, and relevance to the research objectives. Feedback from the pilot study participants was incorporated into the final version of the questionnaire to enhance its validity and reliability.

Sample size calculation

The sample size for this study was determined based on a 95% confidence level, considering a hypothesized population proportion of 11% with a 5% margin of error. The anticipated frequency of this outcome factor was derived from a previous study [ 13 ]. The population size was estimated to be 200,000. Using the formula for sample size calculation for frequency in a population (n = [DEFF * N * p * (1-p)] / [(d^2 / Z^2) * (N-1) + p * (1-p)]), where DEFF represents the design effect, N is the population size, p is the hypothesized proportion, d is the margin of error, and Z is the critical value corresponding to the desired confidence level, the required sample size was determined to be approximately 151 participants.

Data analysis and synthesis

After data collection, the collected data were subjected to comprehensive analysis using SPSS version 22.0. Descriptive statistics, such as frequencies and percentages were computed to summarize the data and gain insights into the training and practices of doctors in breaking bad news.

The qualitative part of the study aimed to gain insights into the practices and challenges associated with breaking bad news in a healthcare setting. The qualitative data were gathered through in-depth interviews with 13 medical educationists from Pakistan. Each interview lasted between 30 and 45 min and took place in the office spaces of the participants to ensure privacy and confidentiality. The participants were individuals who had been involved in teaching medicine for at least 5 years, including 6 clinicians, 4 individuals from medical education, and 3 from basic sciences departments. The interviews were conducted by the principal investigator along with a medical student who accompanied as a note-taker. Rigorous note-taking was done during the interviews to capture detailed information, and where possible, the interviews were audio recorded and later transcribed for analysis. The Braun and Clarke’s thematic analysis method was used as an iterative process which consisted of six steps: (1) becoming familiar with the data, (2) generating codes, (3) generating themes, (4) reviewing themes, (5) defining and naming themes, and (6) locating exemplars [ 14 ]. The analysis was conducted by carefully reading and familiarizing with the interview transcripts. Codes were generated to label and categorize meaningful segments of data, which were refined and grouped into broader themes. The research team engaged in discussions to validate the emerging themes and ensure the reliability of the analysis.

Demographic data of the participants showed that out of the total 151 respondents males were greater in number than females (62.3%), mean age was 30.7(± 8.6 SD) years and the proportion of house officers was the highest, as shown in Table  1 . Response rate of the employees of private hospitals was higher than that of the public sector and there were graduates from several medical institutions all over Pakistan.

Table  2 illustrates the responses to various questions related to BBN. Out of the total respondents, 74% reported that BBN was included in their daily duties, indicating that a significant majority of doctors in Pakistan are involved in delivering difficult news to their patients. However, only 9% of the participants reported receiving training specifically focused on BBN, while the remaining 91% had not received such training.

When considering the tenure of the BBN training, a small percentage of doctors (2%) reported receiving training during their MBBS education, followed by 3% during their house job, and 3% during postgraduate training. Surprisingly, the majority of respondents (92%) relied on personal experience rather than formal training to navigate the challenges of BBN. Regarding the availability of formal guidelines for BBN, only 10% of the participants reported having access to such guidelines, while the majority (90%) did not have formal guidelines to follow.

Maintaining privacy during the process of BBN was reported by 14% of the participants, indicating that privacy considerations may not be adequately addressed in some healthcare settings. Similarly, patient attendants’ involvement during the BBN was reported by 78% of the respondents, suggesting that involving family members or caregivers in the process is common.

When it comes to communication techniques during BBN, 64% of doctors reported sitting while delivering the news, while 36% did not. Time and interruption management, rapport building, patient perception exploration, and adequate patient speaking time were areas where improvements were needed, as reported by the participants.

Furthermore, while 52% of the respondents reported avoiding excessive bluntness and handling emotions appropriately, a considerable portion (48%) did not prioritize these aspects. Identification of emotional state, empathic response, and providing time for personal expression were areas where improvements were necessary, as reported by the participants. Moreover, the participants acknowledged the importance of avoiding jargon and technical terms (44%) and breaking the information into small chunks (45%) to enhance patient understanding. However, further efforts were needed to ensure that hopelessness was avoided during the conversation (50%).

Regarding prognosis and treatment options, 20% of the doctors reported discussing these aspects during BBN conversations, indicating that there is room for improvement in ensuring comprehensive information delivery and empathetic counseling.

In summary, the results highlight several areas where training and guidelines for BBN in Pakistan can be improved. The majority of doctors rely on personal experience rather than formal training, indicating a need for structured educational programs and guidelines in this critical area of healthcare communication. Privacy considerations, effective communication techniques, and emotional support for patients were identified as areas that require further attention and development. The findings emphasize the importance of enhancing training and providing formal guidelines to equip doctors with the necessary skills and strategies for delivering difficult news effectively and compassionately.

The qualitative component of the study involved in-depth interviews with 13 medical educationists from Pakistan. These interviews aimed to explore the level and standard of training on BBN in the curriculum and training of doctors in Pakistan. The interviews revealed several key themes that shed light on the current state of training and education in this area.

Theme 1: ambiguity in subject domains and integration of communication skills

The medical educationists expressed concerns regarding the lack of clarity in subject domains and the integration of communication skills into the medical curriculum. They suggested that communication skills, including BBN, should be incorporated into the community medicine curriculum. Furthermore, they proposed the introduction of family medicine as a dedicated subject at the undergraduate level, which would provide comprehensive training in communication skills and prepare doctors to handle sensitive conversations effectively.

One interviewee highlighted, “There is a lack of clarity when it comes to subject domains and the inclusion of communication skills in our medical curriculum. We believe that communication skills, including breaking bad news, should be integrated into the community medicine curriculum. Additionally, introducing family medicine as a dedicated subject at the undergraduate level would ensure that doctors receive extensive training in effective communication, addressing the emotional needs of patients and their families.” [P6].

This theme emphasizes the need for clear subject domains and the integration of communication skills including BBN within medical education. The proposal to introduce family medicine as an undergraduate subject reflects a holistic approach to training future doctors in effectively delivering difficult news and addressing the diverse needs of patients and their families.

Theme 2: limited importance of breaking bad news in medical education

The medical educationists expressed that at present BBN does not hold a significant place in the teaching and training of doctors in Pakistan. The focus is primarily on technical clinical knowledge and skill development, often neglecting important soft skills such as communication skills, research skills, and logistics. This lack of emphasis on communication training implies that doctors may not be adequately prepared to handle the complexities of BBN and managing the subsequent situations effectively.

During the interviews, one medical educationist highlighted, “In our curriculum, there is a major gap when it comes to training doctors in breaking bad news. The focus is more on technical aspects, and soft skills like communication are often overlooked. This can lead to doctors struggling in delivering difficult news and navigating the emotional complexities that follow.“ [P1].

The participants also expressed concerns about the limited exposure and opportunities for doctors to stay up to date with constantly evolving medical knowledge. They emphasized the importance of continuous professional development to ensure doctors are equipped with the latest information and best practices in BBN effectively.

One interviewee shared, “It is crucial for doctors to have appropriate exposure to stay updated with the latest medical knowledge. Breaking bad news requires not only clinical expertise but also an understanding of the emotional and psychological aspects. Continuous professional development programs can help doctors refine their skills and keep abreast of the advancements in this field.” [P3].

Theme 3: learning by example and long-term impact of communication

The interviewees emphasized that BBN cannot be solely taught through theoretical instruction but should be demonstrated through practical examples and role modeling. They highlighted the significance of the communication process itself, as it can have long-term effects on the lives of patients and their families.

An interviewee emphasized, “It’s not just about teaching the process of breaking bad news; it’s about demonstrating empathy, active listening, and providing support throughout the entire journey. Learning by example and observing experienced doctors can be invaluable in developing the necessary communication skills. We must realize that the way we communicate with people during difficult times can have a profound impact on their well-being.” [P2].

Theme 4: lack of standardized training and guidelines

The medical educationists highlighted the absence of standardized training programs and guidelines specifically tailored to breaking bad news in Pakistan. They emphasized the need for a structured curriculum that includes comprehensive training modules and clear guidelines to ensure consistent and effective communication when delivering difficult news.

One interviewee stated, “There is a lack of standardized training and guidelines for breaking bad news in our medical education system. Without a structured curriculum and clear guidelines, doctors may face challenges in approaching these sensitive conversations. Establishing standardized training programs would provide doctors with the necessary tools and frameworks to navigate such situations effectively.” [P4].

Theme 5: inter-professional collaboration and team-based approach

The interviewees emphasized the importance of inter-professional collaboration and a team-based approach in BBN. They highlighted the need for effective communication and coordination among healthcare professionals, including doctors, nurses, psychologists, and social workers, to provide comprehensive support to patients and their families.

One medical educationist shared, “Breaking bad news is a complex process that requires a team-based approach. It is crucial for doctors to collaborate with other healthcare professionals, such as nurses, psychologists, and social workers, to ensure holistic care and support for patients and their families. Promoting effective inter-professional communication is essential in delivering sensitive news with empathy and addressing the diverse needs of patients.” [P7].

The present study aimed to explore the practices and training of clinicians in BBN to patients and their care givers in Pakistan. The combination of quantitative and qualitative findings, along with comparisons drawn from other studies conducted in developing countries, provides a comprehensive understanding of the current state of BBN practices and training in Pakistan and its relation to similar contexts.

Breaking bad news is part of the daily duties of almost all the clinicians. A study conducted in Sudan found that 56% of physicians had received training in BBN, indicating a relatively lower percentage compared to our study [ 15 ]. Similarly, a study from Ethiopia reported that 82% of participant physicians were not even aware of the SPIKES protocol, and 84% had no formal or informal training in BBN [ 8 ]. These findings suggest that the level of training and awareness regarding BBN varies across different developing countries. In our study revealed that only 9% of the participants reported receiving formal training specifically focused on BBN. This finding is consistent with studies conducted in other developing countries. For instance, a study from Lahore, Pakistan, involving postgraduate trainees, found a lack of knowledge and low satisfaction regarding BBN skills [ 16 ]. Similarly, a study in Peshawar, Pakistan, reported that 95% of participants had no training in BBN, highlighting a common gap in training among healthcare professionals [ 12 ]. Despite the fact that there is no formal training on BBN, the self-reported data in our study is quite positive.

The qualitative component of the study added valuable insights to complement the quantitative findings. Through in-depth interviews, participants’ experiences, perspectives, and challenges regarding BBN were explored. This approach provided a deeper understanding of the participants’ thoughts, emotions, and contextual factors influencing their communication practices. Themes and patterns emerged, offering a nuanced understanding of the quantitative results. The qualitative component also captured participants’ perceptions of training effectiveness, suggestions for improvement, and barriers to implementing optimal communication practices. Nonetheless, respondents were of the view that either at undergraduate or as part of the continuing education, inclusion of BBN training must be considered and that there should be a structured curriculum. However, there is an incongruent viewpoint too where some respondents said that skills of BBN come with experiential learning and maturity, and that it is about exhibiting one’s empathetic attitude and care during difficult times. This mixed methods approach allowed for a comprehensive examination of the research questions, generating practical implications for improving physician practices in breaking bad news [ 16 , 17 ].

Comparisons drawn from other developing countries also highlight the need for standardized training programs and guidelines for BBN. For instance, according to one research, adherence to the SPIKES protocol varied among participants, with 35–79% claiming to follow the protocol in routine practice [ 15 ]. Similarly, a study in Ethiopia found that a significant percentage of physicians were not complying with the guidelines of BBN [ 17 ]. These findings indicate the need for structured curricula and clear guidelines to ensure consistent and effective communication skills amongst doctors [ 18 ]. The importance of paying enough attention to the emotions of the recipient and the need to provide support after breaking bad news cannot be undermined at all [ 19 ]. A cultural shift is required within the medical profession and healthcare more generally so that BBN is viewed not merely as a soft skill but a professional responsibility for the doctor and a right for the patients and families who wish to have it [ 20 ].

Limitations

Our study has few limitations too. Very few participants were of the consultant cadre, most of the responded were junior doctors. Patients as well as the care givers are important stakeholders in this issue. Their views and perceptions were not explored in qualitative component of the study.

This study offers valuable insights into the practices and training of clinicians involved in BBN in Pakistan. Comparisons with other studies conducted in developing countries reveal both similarities and differences in BBN practices and training. The findings underscore the necessity of standardized training programs, formal guidelines, and improved communication skills education within medical curricula across developing nations. Recommendations arising from this study include integrating communication skills into the medical curriculum, developing standardized training programs, promoting continuous professional development, fostering inter-professional collaboration, and recognizing the importance of communication skills. By taking these steps, healthcare professionals will be equipped with the necessary tools to navigate the complexities of breaking bad news effectively and to provide compassionate care. Collaboration among medical institutions, policymakers, and regulatory bodies is essential to prioritize communication skills training, establish clear guidelines, and emphasize the value of empathetic and effective communication. Efforts should be directed towards increasing awareness, providing comprehensive training, and emphasizing the significance of effective communication when delivering difficult news, thus ensuring optimal patient care and support during challenging situations. Implementation of these recommendations will enhance the delivery of difficult news, increase patient satisfaction, and ensure comprehensive support during challenging times.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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MAA & BTS were involved in conception and design of the study; MAA, KRK and MAY did the data collection, analysis and interpretation of the literature; and later developed the first draft of the paper; BTS helped in triangulation and contributed in revising it critically for substantial intellectual content and for adding references. All authors read and approved the final manuscript.

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Abdullah, M.A., Shaikh, B.T., Khan, K.R. et al. Breaking bad news: A mix methods study reporting the need for improving communication skills among doctors in Pakistan. BMC Health Serv Res 24 , 588 (2024). https://doi.org/10.1186/s12913-024-11056-2

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