five qualitative research methods

5 Types of Qualitative Methods

But just as with quantitative methods, there are actually many varieties of qualitative methods.

Similar to the way you can group usability testing methods , there are also a number of ways to segment qualitative methods.

A popular and helpful categorization separate qualitative methods into five groups: ethnography, narrative, phenomenological, grounded theory, and case study. John Creswell outlines these five methods in Qualitative Inquiry and Research Design .

While the five methods generally use similar data collection techniques (observation, interviews, and reviewing text), the purpose of the study differentiates them—something similar with different types of usability tests . And like classifying different usability studies, the differences between the methods can be a bit blurry. Here are the five qualitative methods in more detail.

1. Ethnography

Ethnographic research is probably the most familiar and applicable type of qualitative method to UX professionals. In ethnography, you immerse yourself in the target participants’ environment to understand the goals, cultures, challenges, motivations, and themes that emerge. Ethnography has its roots in cultural anthropology where researchers immerse themselves within a culture, often for years! Rather than relying on interviews or surveys, you experience the environment first hand, and sometimes as a “participant observer.”

For example, one way of uncovering the unmet needs of customers is to “ follow them home ” and observe them as they interact with the product. You don’t come armed with any hypotheses to necessarily test; rather, you’re looking to find out how a product is used.

2. Narrative

The narrative approach weaves together a sequence of events, usually from just one or two individuals to form a cohesive story. You conduct in-depth interviews, read documents, and look for themes; in other words, how does an individual story illustrate the larger life influences that created it. Often interviews are conducted over weeks, months, or even years, but the final narrative doesn’t need to be in chronological order. Rather it can be presented as a story (or narrative) with themes, and can reconcile conflicting stories and highlight tensions and challenges which can be opportunities for innovation.

For example, a narrative approach can be an appropriate method for building a persona . While a persona should be built using a mix of methods—including segmentation analysis from surveys—in-depth interviews with individuals in an identified persona can provide the details that help describe the culture, whether it’s a person living with Multiple Sclerosis, a prospective student applying for college, or a working mom.

3. Phenomenological

When you want to describe an event, activity, or phenomenon, the aptly named phenomenological study is an appropriate qualitative method. In a phenomenological study, you use a combination of methods, such as conducting interviews, reading documents, watching videos, or visiting places and events, to understand the meaning participants place on whatever’s being examined. You rely on the participants’ own perspectives to provide insight into their motivations.

Like other qualitative methods, you don’t start with a well-formed hypothesis. In a phenomenological study, you often conduct a lot of interviews, usually between 5 and 25 for common themes , to build a sufficient dataset to look for emerging themes and to use other participants to validate your findings.

For example, there’s been an explosion in the last 5 years in online courses and training. But how do students engage with these courses? While you can examine time spent and content accessed using log data and even assess student achievement vis-a-vis in-person courses, a phenomenological study would aim to better understand the students experience and how that may impact comprehension of the material.

4. Grounded Theory

Whereas a phenomenological study looks to describe the essence of an activity or event, grounded theory looks to provide an explanation or theory behind the events. You use primarily interviews and existing documents to build a theory based on the data. You go through a series of open and axial coding techniques to identify themes and build the theory. Sample sizes are often also larger—between 20 to 60—with these studies to better establish a theory. Grounded theory can help inform design decisions by better understanding how a community of users currently use a product or perform tasks.

For example, a grounded theory study could involve understanding how software developers use portals to communicate and write code or how small retail merchants approve or decline customers for credit.

5. Case Study

Made famous by the Harvard Business School, even mainly quantitative researchers can relate to the value of the case study in explaining an organization, entity, company, or event. A case study involves a deep understanding through multiple types of data sources. Case studies can be explanatory, exploratory, or describing an event. The annual CHI conference has a peer-reviewed track dedicated to case studies.

For example, a case study of how a large multi-national company introduced UX methods into an agile development environment would be informative to many organizations.

The table below summarizes the differences between the five qualitative methods.

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• What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

Published on 4 April 2022 by Pritha Bhandari . Revised on 30 January 2023.

Qualitative research involves collecting and analysing non-numerical data (e.g., text, video, or audio) to understand concepts, opinions, or experiences. It can be used to gather in-depth insights into a problem or generate new ideas for research.

Qualitative research is the opposite of quantitative research , which involves collecting and analysing numerical data for statistical analysis.

Qualitative research is commonly used in the humanities and social sciences, in subjects such as anthropology, sociology, education, health sciences, and history.

• How does social media shape body image in teenagers?
• How do children and adults interpret healthy eating in the UK?
• What factors influence employee retention in a large organisation?
• How is anxiety experienced around the world?
• How can teachers integrate social issues into science curriculums?

Table of contents

Approaches to qualitative research, qualitative research methods, qualitative data analysis, advantages of qualitative research, disadvantages of qualitative research, frequently asked questions about qualitative research.

Qualitative research is used to understand how people experience the world. While there are many approaches to qualitative research, they tend to be flexible and focus on retaining rich meaning when interpreting data.

Common approaches include grounded theory, ethnography, action research, phenomenological research, and narrative research. They share some similarities, but emphasise different aims and perspectives.

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Each of the research approaches involve using one or more data collection methods . These are some of the most common qualitative methods:

• Observations: recording what you have seen, heard, or encountered in detailed field notes.
• Interviews:  personally asking people questions in one-on-one conversations.
• Focus groups: asking questions and generating discussion among a group of people.
• Surveys : distributing questionnaires with open-ended questions.
• Secondary research: collecting existing data in the form of texts, images, audio or video recordings, etc.
• You take field notes with observations and reflect on your own experiences of the company culture.
• You distribute open-ended surveys to employees across all the company’s offices by email to find out if the culture varies across locations.
• You conduct in-depth interviews with employees in your office to learn about their experiences and perspectives in greater detail.

Qualitative researchers often consider themselves ‘instruments’ in research because all observations, interpretations and analyses are filtered through their own personal lens.

For this reason, when writing up your methodology for qualitative research, it’s important to reflect on your approach and to thoroughly explain the choices you made in collecting and analysing the data.

Qualitative data can take the form of texts, photos, videos and audio. For example, you might be working with interview transcripts, survey responses, fieldnotes, or recordings from natural settings.

Most types of qualitative data analysis share the same five steps:

• Prepare and organise your data. This may mean transcribing interviews or typing up fieldnotes.
• Review and explore your data. Examine the data for patterns or repeated ideas that emerge.
• Develop a data coding system. Based on your initial ideas, establish a set of codes that you can apply to categorise your data.
• Assign codes to the data. For example, in qualitative survey analysis, this may mean going through each participant’s responses and tagging them with codes in a spreadsheet. As you go through your data, you can create new codes to add to your system if necessary.
• Identify recurring themes. Link codes together into cohesive, overarching themes.

There are several specific approaches to analysing qualitative data. Although these methods share similar processes, they emphasise different concepts.

Qualitative research often tries to preserve the voice and perspective of participants and can be adjusted as new research questions arise. Qualitative research is good for:

• Flexibility

The data collection and analysis process can be adapted as new ideas or patterns emerge. They are not rigidly decided beforehand.

• Natural settings

Data collection occurs in real-world contexts or in naturalistic ways.

• Meaningful insights

Detailed descriptions of people’s experiences, feelings and perceptions can be used in designing, testing or improving systems or products.

• Generation of new ideas

Open-ended responses mean that researchers can uncover novel problems or opportunities that they wouldn’t have thought of otherwise.

Researchers must consider practical and theoretical limitations in analysing and interpreting their data. Qualitative research suffers from:

• Unreliability

The real-world setting often makes qualitative research unreliable because of uncontrolled factors that affect the data.

• Subjectivity

Due to the researcher’s primary role in analysing and interpreting data, qualitative research cannot be replicated . The researcher decides what is important and what is irrelevant in data analysis, so interpretations of the same data can vary greatly.

• Limited generalisability

Small samples are often used to gather detailed data about specific contexts. Despite rigorous analysis procedures, it is difficult to draw generalisable conclusions because the data may be biased and unrepresentative of the wider population .

• Labour-intensive

Although software can be used to manage and record large amounts of text, data analysis often has to be checked or performed manually.

Quantitative research deals with numbers and statistics, while qualitative research deals with words and meanings.

Quantitative methods allow you to test a hypothesis by systematically collecting and analysing data, while qualitative methods allow you to explore ideas and experiences in depth.

There are five common approaches to qualitative research :

• Grounded theory involves collecting data in order to develop new theories.
• Ethnography involves immersing yourself in a group or organisation to understand its culture.
• Narrative research involves interpreting stories to understand how people make sense of their experiences and perceptions.
• Phenomenological research involves investigating phenomena through people’s lived experiences.
• Action research links theory and practice in several cycles to drive innovative changes.

Data collection is the systematic process by which observations or measurements are gathered in research. It is used in many different contexts by academics, governments, businesses, and other organisations.

There are various approaches to qualitative data analysis , but they all share five steps in common:

• Prepare and organise your data.
• Review and explore your data.
• Develop a data coding system.
• Assign codes to the data.
• Identify recurring themes.

The specifics of each step depend on the focus of the analysis. Some common approaches include textual analysis , thematic analysis , and discourse analysis .

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Qualitative Research: Characteristics, Design, Methods & Examples

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Qualitative research is a type of research methodology that focuses on gathering and analyzing non-numerical data to gain a deeper understanding of human behavior, experiences, and perspectives.

It aims to explore the “why” and “how” of a phenomenon rather than the “what,” “where,” and “when” typically addressed by quantitative research.

Unlike quantitative research, which focuses on gathering and analyzing numerical data for statistical analysis, qualitative research involves researchers interpreting data to identify themes, patterns, and meanings.

Qualitative research can be used to:

• Gain deep contextual understandings of the subjective social reality of individuals
• To answer questions about experience and meaning from the participant’s perspective
• To design hypotheses, theory must be researched using qualitative methods to determine what is important before research can begin. 

Examples of qualitative research questions include: 

• How does stress influence young adults’ behavior?
• What factors influence students’ school attendance rates in developed countries?
• How do adults interpret binge drinking in the UK?
• What are the psychological impacts of cervical cancer screening in women?
• How can mental health lessons be integrated into the school curriculum? 

Characteristics 

Naturalistic setting.

Individuals are studied in their natural setting to gain a deeper understanding of how people experience the world. This enables the researcher to understand a phenomenon close to how participants experience it. 

Naturalistic settings provide valuable contextual information to help researchers better understand and interpret the data they collect.

The environment, social interactions, and cultural factors can all influence behavior and experiences, and these elements are more easily observed in real-world settings.

Reality is socially constructed

Qualitative research aims to understand how participants make meaning of their experiences – individually or in social contexts. It assumes there is no objective reality and that the social world is interpreted (Yilmaz, 2013). 

The primacy of subject matter 

The primary aim of qualitative research is to understand the perspectives, experiences, and beliefs of individuals who have experienced the phenomenon selected for research rather than the average experiences of groups of people (Minichiello, 1990).

An in-depth understanding is attained since qualitative techniques allow participants to freely disclose their experiences, thoughts, and feelings without constraint (Tenny et al., 2022). 

Variables are complex, interwoven, and difficult to measure

Factors such as experiences, behaviors, and attitudes are complex and interwoven, so they cannot be reduced to isolated variables , making them difficult to measure quantitatively.

However, a qualitative approach enables participants to describe what, why, or how they were thinking/ feeling during a phenomenon being studied (Yilmaz, 2013). 

Emic (insider’s point of view)

The phenomenon being studied is centered on the participants’ point of view (Minichiello, 1990).

Emic is used to describe how participants interact, communicate, and behave in the research setting (Scarduzio, 2017).

Interpretive analysis

In qualitative research, interpretive analysis is crucial in making sense of the collected data.

This process involves examining the raw data, such as interview transcripts, field notes, or documents, and identifying the underlying themes, patterns, and meanings that emerge from the participants’ experiences and perspectives.

Collecting Qualitative Data

There are four main research design methods used to collect qualitative data: observations, interviews,  focus groups, and ethnography.

Observations

This method involves watching and recording phenomena as they occur in nature. Observation can be divided into two types: participant and non-participant observation.

In participant observation, the researcher actively participates in the situation/events being observed.

In non-participant observation, the researcher is not an active part of the observation and tries not to influence the behaviors they are observing (Busetto et al., 2020). 

Observations can be covert (participants are unaware that a researcher is observing them) or overt (participants are aware of the researcher’s presence and know they are being observed).

However, awareness of an observer’s presence may influence participants’ behavior. 

Interviews give researchers a window into the world of a participant by seeking their account of an event, situation, or phenomenon. They are usually conducted on a one-to-one basis and can be distinguished according to the level at which they are structured (Punch, 2013). 

Structured interviews involve predetermined questions and sequences to ensure replicability and comparability. However, they are unable to explore emerging issues.

Informal interviews consist of spontaneous, casual conversations which are closer to the truth of a phenomenon. However, information is gathered using quick notes made by the researcher and is therefore subject to recall bias. 

Semi-structured interviews have a flexible structure, phrasing, and placement so emerging issues can be explored (Denny & Weckesser, 2022).

The use of probing questions and clarification can lead to a detailed understanding, but semi-structured interviews can be time-consuming and subject to interviewer bias. 

Focus groups 

Similar to interviews, focus groups elicit a rich and detailed account of an experience. However, focus groups are more dynamic since participants with shared characteristics construct this account together (Denny & Weckesser, 2022).

A shared narrative is built between participants to capture a group experience shaped by a shared context. 

The researcher takes on the role of a moderator, who will establish ground rules and guide the discussion by following a topic guide to focus the group discussions.

Typically, focus groups have 4-10 participants as a discussion can be difficult to facilitate with more than this, and this number allows everyone the time to speak.

Ethnography

Ethnography is a methodology used to study a group of people’s behaviors and social interactions in their environment (Reeves et al., 2008).

Data are collected using methods such as observations, field notes, or structured/ unstructured interviews.

The aim of ethnography is to provide detailed, holistic insights into people’s behavior and perspectives within their natural setting. In order to achieve this, researchers immerse themselves in a community or organization. 

Due to the flexibility and real-world focus of ethnography, researchers are able to gather an in-depth, nuanced understanding of people’s experiences, knowledge and perspectives that are influenced by culture and society.

In order to develop a representative picture of a particular culture/ context, researchers must conduct extensive field work. 

This can be time-consuming as researchers may need to immerse themselves into a community/ culture for a few days, or possibly a few years.

Qualitative Data Analysis Methods

Different methods can be used for analyzing qualitative data. The researcher chooses based on the objectives of their study. 

The researcher plays a key role in the interpretation of data, making decisions about the coding, theming, decontextualizing, and recontextualizing of data (Starks & Trinidad, 2007). 

Grounded theory

Grounded theory is a qualitative method specifically designed to inductively generate theory from data. It was developed by Glaser and Strauss in 1967 (Glaser & Strauss, 2017).

 This methodology aims to develop theories (rather than test hypotheses) that explain a social process, action, or interaction (Petty et al., 2012). To inform the developing theory, data collection and analysis run simultaneously. 

There are three key types of coding used in grounded theory: initial (open), intermediate (axial), and advanced (selective) coding. 

Throughout the analysis, memos should be created to document methodological and theoretical ideas about the data. Data should be collected and analyzed until data saturation is reached and a theory is developed. 

Content analysis

Content analysis was first used in the early twentieth century to analyze textual materials such as newspapers and political speeches.

Content analysis is a research method used to identify and analyze the presence and patterns of themes, concepts, or words in data (Vaismoradi et al., 2013). 

This research method can be used to analyze data in different formats, which can be written, oral, or visual. 

The goal of content analysis is to develop themes that capture the underlying meanings of data (Schreier, 2012). 

Qualitative content analysis can be used to validate existing theories, support the development of new models and theories, and provide in-depth descriptions of particular settings or experiences.

The following six steps provide a guideline for how to conduct qualitative content analysis.

• Define a Research Question : To start content analysis, a clear research question should be developed.
• Identify and Collect Data : Establish the inclusion criteria for your data. Find the relevant sources to analyze.
• Define the Unit or Theme of Analysis : Categorize the content into themes. Themes can be a word, phrase, or sentence.
• Develop Rules for Coding your Data : Define a set of coding rules to ensure that all data are coded consistently.
• Code the Data : Follow the coding rules to categorize data into themes.
• Analyze the Results and Draw Conclusions : Examine the data to identify patterns and draw conclusions in relation to your research question.

Discourse analysis

Discourse analysis is a research method used to study written/ spoken language in relation to its social context (Wood & Kroger, 2000).

In discourse analysis, the researcher interprets details of language materials and the context in which it is situated.

Discourse analysis aims to understand the functions of language (how language is used in real life) and how meaning is conveyed by language in different contexts. Researchers use discourse analysis to investigate social groups and how language is used to achieve specific communication goals.

Different methods of discourse analysis can be used depending on the aims and objectives of a study. However, the following steps provide a guideline on how to conduct discourse analysis.

• Define the Research Question : Develop a relevant research question to frame the analysis.
• Gather Data and Establish the Context : Collect research materials (e.g., interview transcripts, documents). Gather factual details and review the literature to construct a theory about the social and historical context of your study.
• Analyze the Content : Closely examine various components of the text, such as the vocabulary, sentences, paragraphs, and structure of the text. Identify patterns relevant to the research question to create codes, then group these into themes.
• Review the Results : Reflect on the findings to examine the function of the language, and the meaning and context of the discourse. 

Thematic analysis

Thematic analysis is a method used to identify, interpret, and report patterns in data, such as commonalities or contrasts. 

Although the origin of thematic analysis can be traced back to the early twentieth century, understanding and clarity of thematic analysis is attributed to Braun and Clarke (2006).

Thematic analysis aims to develop themes (patterns of meaning) across a dataset to address a research question. 

In thematic analysis, qualitative data is gathered using techniques such as interviews, focus groups, and questionnaires. Audio recordings are transcribed. The dataset is then explored and interpreted by a researcher to identify patterns. 

This occurs through the rigorous process of data familiarisation, coding, theme development, and revision. These identified patterns provide a summary of the dataset and can be used to address a research question.

Themes are developed by exploring the implicit and explicit meanings within the data. Two different approaches are used to generate themes: inductive and deductive. 

An inductive approach allows themes to emerge from the data. In contrast, a deductive approach uses existing theories or knowledge to apply preconceived ideas to the data.

Phases of Thematic Analysis

Braun and Clarke (2006) provide a guide of the six phases of thematic analysis. These phases can be applied flexibly to fit research questions and data. 

Template analysis

Template analysis refers to a specific method of thematic analysis which uses hierarchical coding (Brooks et al., 2014).

Template analysis is used to analyze textual data, for example, interview transcripts or open-ended responses on a written questionnaire.

To conduct template analysis, a coding template must be developed (usually from a subset of the data) and subsequently revised and refined. This template represents the themes identified by researchers as important in the dataset. 

Codes are ordered hierarchically within the template, with the highest-level codes demonstrating overarching themes in the data and lower-level codes representing constituent themes with a narrower focus.

A guideline for the main procedural steps for conducting template analysis is outlined below.

• Familiarization with the Data : Read (and reread) the dataset in full. Engage, reflect, and take notes on data that may be relevant to the research question.
• Preliminary Coding : Identify initial codes using guidance from the a priori codes, identified before the analysis as likely to be beneficial and relevant to the analysis.
• Organize Themes : Organize themes into meaningful clusters. Consider the relationships between the themes both within and between clusters.
• Produce an Initial Template : Develop an initial template. This may be based on a subset of the data.
• Apply and Develop the Template : Apply the initial template to further data and make any necessary modifications. Refinements of the template may include adding themes, removing themes, or changing the scope/title of themes. 
• Finalize Template : Finalize the template, then apply it to the entire dataset. 

Frame analysis

Frame analysis is a comparative form of thematic analysis which systematically analyzes data using a matrix output.

Ritchie and Spencer (1994) developed this set of techniques to analyze qualitative data in applied policy research. Frame analysis aims to generate theory from data.

Frame analysis encourages researchers to organize and manage their data using summarization.

This results in a flexible and unique matrix output, in which individual participants (or cases) are represented by rows and themes are represented by columns. 

Each intersecting cell is used to summarize findings relating to the corresponding participant and theme.

Frame analysis has five distinct phases which are interrelated, forming a methodical and rigorous framework.

• Familiarization with the Data : Familiarize yourself with all the transcripts. Immerse yourself in the details of each transcript and start to note recurring themes.
• Develop a Theoretical Framework : Identify recurrent/ important themes and add them to a chart. Provide a framework/ structure for the analysis.
• Indexing : Apply the framework systematically to the entire study data.
• Summarize Data in Analytical Framework : Reduce the data into brief summaries of participants’ accounts.
• Mapping and Interpretation : Compare themes and subthemes and check against the original transcripts. Group the data into categories and provide an explanation for them.

Preventing Bias in Qualitative Research

To evaluate qualitative studies, the CASP (Critical Appraisal Skills Programme) checklist for qualitative studies can be used to ensure all aspects of a study have been considered (CASP, 2018).

The quality of research can be enhanced and assessed using criteria such as checklists, reflexivity, co-coding, and member-checking. 

Co-coding 

Relying on only one researcher to interpret rich and complex data may risk key insights and alternative viewpoints being missed. Therefore, coding is often performed by multiple researchers.

A common strategy must be defined at the beginning of the coding process  (Busetto et al., 2020). This includes establishing a useful coding list and finding a common definition of individual codes.

Transcripts are initially coded independently by researchers and then compared and consolidated to minimize error or bias and to bring confirmation of findings. 

Member checking

Member checking (or respondent validation) involves checking back with participants to see if the research resonates with their experiences (Russell & Gregory, 2003).

Data can be returned to participants after data collection or when results are first available. For example, participants may be provided with their interview transcript and asked to verify whether this is a complete and accurate representation of their views.

Participants may then clarify or elaborate on their responses to ensure they align with their views (Shenton, 2004).

This feedback becomes part of data collection and ensures accurate descriptions/ interpretations of phenomena (Mays & Pope, 2000). 

Reflexivity in qualitative research

Reflexivity typically involves examining your own judgments, practices, and belief systems during data collection and analysis. It aims to identify any personal beliefs which may affect the research. 

Reflexivity is essential in qualitative research to ensure methodological transparency and complete reporting. This enables readers to understand how the interaction between the researcher and participant shapes the data.

Depending on the research question and population being researched, factors that need to be considered include the experience of the researcher, how the contact was established and maintained, age, gender, and ethnicity.

These details are important because, in qualitative research, the researcher is a dynamic part of the research process and actively influences the outcome of the research (Boeije, 2014). 

Reflexivity Example

Who you are and your characteristics influence how you collect and analyze data. Here is an example of a reflexivity statement for research on smoking. I am a 30-year-old white female from a middle-class background. I live in the southwest of England and have been educated to master’s level. I have been involved in two research projects on oral health. I have never smoked, but I have witnessed how smoking can cause ill health from my volunteering in a smoking cessation clinic. My research aspirations are to help to develop interventions to help smokers quit.

Establishing Trustworthiness in Qualitative Research

Trustworthiness is a concept used to assess the quality and rigor of qualitative research. Four criteria are used to assess a study’s trustworthiness: credibility, transferability, dependability, and confirmability.

Credibility in Qualitative Research

Credibility refers to how accurately the results represent the reality and viewpoints of the participants.

To establish credibility in research, participants’ views and the researcher’s representation of their views need to align (Tobin & Begley, 2004).

To increase the credibility of findings, researchers may use data source triangulation, investigator triangulation, peer debriefing, or member checking (Lincoln & Guba, 1985). 

Transferability in Qualitative Research

Transferability refers to how generalizable the findings are: whether the findings may be applied to another context, setting, or group (Tobin & Begley, 2004).

Transferability can be enhanced by giving thorough and in-depth descriptions of the research setting, sample, and methods (Nowell et al., 2017). 

Dependability in Qualitative Research

Dependability is the extent to which the study could be replicated under similar conditions and the findings would be consistent.

Researchers can establish dependability using methods such as audit trails so readers can see the research process is logical and traceable (Koch, 1994).

Confirmability in Qualitative Research

Confirmability is concerned with establishing that there is a clear link between the researcher’s interpretations/ findings and the data.

Researchers can achieve confirmability by demonstrating how conclusions and interpretations were arrived at (Nowell et al., 2017).

This enables readers to understand the reasoning behind the decisions made. 

Audit Trails in Qualitative Research

An audit trail provides evidence of the decisions made by the researcher regarding theory, research design, and data collection, as well as the steps they have chosen to manage, analyze, and report data. 

The researcher must provide a clear rationale to demonstrate how conclusions were reached in their study.

A clear description of the research path must be provided to enable readers to trace through the researcher’s logic (Halpren, 1983).

Researchers should maintain records of the raw data, field notes, transcripts, and a reflective journal in order to provide a clear audit trail. 

Discovery of unexpected data

Open-ended questions in qualitative research mean the researcher can probe an interview topic and enable the participant to elaborate on responses in an unrestricted manner.

This allows unexpected data to emerge, which can lead to further research into that topic. 

The exploratory nature of qualitative research helps generate hypotheses that can be tested quantitatively (Busetto et al., 2020).

Flexibility

Data collection and analysis can be modified and adapted to take the research in a different direction if new ideas or patterns emerge in the data.

This enables researchers to investigate new opportunities while firmly maintaining their research goals. 

Naturalistic settings

The behaviors of participants are recorded in real-world settings. Studies that use real-world settings have high ecological validity since participants behave more authentically. 

Limitations

Time-consuming .

Qualitative research results in large amounts of data which often need to be transcribed and analyzed manually.

Even when software is used, transcription can be inaccurate, and using software for analysis can result in many codes which need to be condensed into themes. 

Subjectivity 

The researcher has an integral role in collecting and interpreting qualitative data. Therefore, the conclusions reached are from their perspective and experience.

Consequently, interpretations of data from another researcher may vary greatly. 

Limited generalizability

The aim of qualitative research is to provide a detailed, contextualized understanding of an aspect of the human experience from a relatively small sample size.

Despite rigorous analysis procedures, conclusions drawn cannot be generalized to the wider population since data may be biased or unrepresentative.

Therefore, results are only applicable to a small group of the population. 

Extraneous variables

Qualitative research is often conducted in real-world settings. This may cause results to be unreliable since extraneous variables may affect the data, for example:

• Situational variables : different environmental conditions may influence participants’ behavior in a study. The random variation in factors (such as noise or lighting) may be difficult to control in real-world settings.
• Participant characteristics : this includes any characteristics that may influence how a participant answers/ behaves in a study. This may include a participant’s mood, gender, age, ethnicity, sexual identity, IQ, etc.
• Experimenter effect : experimenter effect refers to how a researcher’s unintentional influence can change the outcome of a study. This occurs when (i) their interactions with participants unintentionally change participants’ behaviors or (ii) due to errors in observation, interpretation, or analysis. 

What sample size should qualitative research be?

The sample size for qualitative studies has been recommended to include a minimum of 12 participants to reach data saturation (Braun, 2013).

Are surveys qualitative or quantitative?

Surveys can be used to gather information from a sample qualitatively or quantitatively. Qualitative surveys use open-ended questions to gather detailed information from a large sample using free text responses.

The use of open-ended questions allows for unrestricted responses where participants use their own words, enabling the collection of more in-depth information than closed-ended questions.

In contrast, quantitative surveys consist of closed-ended questions with multiple-choice answer options. Quantitative surveys are ideal to gather a statistical representation of a population.

What are the ethical considerations of qualitative research?

Before conducting a study, you must think about any risks that could occur and take steps to prevent them. Participant Protection : Researchers must protect participants from physical and mental harm. This means you must not embarrass, frighten, offend, or harm participants. Transparency : Researchers are obligated to clearly communicate how they will collect, store, analyze, use, and share the data. Confidentiality : You need to consider how to maintain the confidentiality and anonymity of participants’ data.

What is triangulation in qualitative research?

Triangulation refers to the use of several approaches in a study to comprehensively understand phenomena. This method helps to increase the validity and credibility of research findings. 

Types of triangulation include method triangulation (using multiple methods to gather data); investigator triangulation (multiple researchers for collecting/ analyzing data), theory triangulation (comparing several theoretical perspectives to explain a phenomenon), and data source triangulation (using data from various times, locations, and people; Carter et al., 2014).

Why is qualitative research important?

Qualitative research allows researchers to describe and explain the social world. The exploratory nature of qualitative research helps to generate hypotheses that can then be tested quantitatively.

In qualitative research, participants are able to express their thoughts, experiences, and feelings without constraint.

Additionally, researchers are able to follow up on participants’ answers in real-time, generating valuable discussion around a topic. This enables researchers to gain a nuanced understanding of phenomena which is difficult to attain using quantitative methods.

What is coding data in qualitative research?

Coding data is a qualitative data analysis strategy in which a section of text is assigned with a label that describes its content.

These labels may be words or phrases which represent important (and recurring) patterns in the data.

This process enables researchers to identify related content across the dataset. Codes can then be used to group similar types of data to generate themes.

What is the difference between qualitative and quantitative research?

Qualitative research involves the collection and analysis of non-numerical data in order to understand experiences and meanings from the participant’s perspective.

This can provide rich, in-depth insights on complicated phenomena. Qualitative data may be collected using interviews, focus groups, or observations.

In contrast, quantitative research involves the collection and analysis of numerical data to measure the frequency, magnitude, or relationships of variables. This can provide objective and reliable evidence that can be generalized to the wider population.

Quantitative data may be collected using closed-ended questionnaires or experiments.

What is trustworthiness in qualitative research?

Trustworthiness is a concept used to assess the quality and rigor of qualitative research. Four criteria are used to assess a study’s trustworthiness: credibility, transferability, dependability, and confirmability. 

Credibility refers to how accurately the results represent the reality and viewpoints of the participants. Transferability refers to whether the findings may be applied to another context, setting, or group.

Dependability is the extent to which the findings are consistent and reliable. Confirmability refers to the objectivity of findings (not influenced by the bias or assumptions of researchers).

What is data saturation in qualitative research?

Data saturation is a methodological principle used to guide the sample size of a qualitative research study.

Data saturation is proposed as a necessary methodological component in qualitative research (Saunders et al., 2018) as it is a vital criterion for discontinuing data collection and/or analysis. 

The intention of data saturation is to find “no new data, no new themes, no new coding, and ability to replicate the study” (Guest et al., 2006). Therefore, enough data has been gathered to make conclusions.

Why is sampling in qualitative research important?

In quantitative research, large sample sizes are used to provide statistically significant quantitative estimates.

This is because quantitative research aims to provide generalizable conclusions that represent populations.

However, the aim of sampling in qualitative research is to gather data that will help the researcher understand the depth, complexity, variation, or context of a phenomenon. The small sample sizes in qualitative studies support the depth of case-oriented analysis.

Boeije, H. (2014). Analysis in qualitative research. Sage.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology , 3 (2), 77-101. https://doi.org/10.1191/1478088706qp063oa

Brooks, J., McCluskey, S., Turley, E., & King, N. (2014). The utility of template analysis in qualitative psychology research. Qualitative Research in Psychology , 12 (2), 202–222. https://doi.org/10.1080/14780887.2014.955224

Busetto, L., Wick, W., & Gumbinger, C. (2020). How to use and assess qualitative research methods. Neurological research and practice , 2 (1), 14-14. https://doi.org/10.1186/s42466-020-00059-z 

Carter, N., Bryant-Lukosius, D., DiCenso, A., Blythe, J., & Neville, A. J. (2014). The use of triangulation in qualitative research. Oncology nursing forum , 41 (5), 545–547. https://doi.org/10.1188/14.ONF.545-547

Critical Appraisal Skills Programme. (2018). CASP Checklist: 10 questions to help you make sense of a Qualitative research. https://casp-uk.net/images/checklist/documents/CASP-Qualitative-Studies-Checklist/CASP-Qualitative-Checklist-2018_fillable_form.pdf Accessed: March 15 2023

Clarke, V., & Braun, V. (2013). Successful qualitative research: A practical guide for beginners. Successful Qualitative Research , 1-400.

Denny, E., & Weckesser, A. (2022). How to do qualitative research?: Qualitative research methods. BJOG : an international journal of obstetrics and gynaecology , 129 (7), 1166-1167. https://doi.org/10.1111/1471-0528.17150 

Glaser, B. G., & Strauss, A. L. (2017). The discovery of grounded theory. The Discovery of Grounded Theory , 1–18. https://doi.org/10.4324/9780203793206-1

Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18 (1), 59-82. doi:10.1177/1525822X05279903

Halpren, E. S. (1983). Auditing naturalistic inquiries: The development and application of a model (Unpublished doctoral dissertation). Indiana University, Bloomington.

Hammarberg, K., Kirkman, M., & de Lacey, S. (2016). Qualitative research methods: When to use them and how to judge them. Human Reproduction , 31 (3), 498–501. https://doi.org/10.1093/humrep/dev334

Koch, T. (1994). Establishing rigour in qualitative research: The decision trail. Journal of Advanced Nursing, 19, 976–986. doi:10.1111/ j.1365-2648.1994.tb01177.x

Lincoln, Y., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.

Mays, N., & Pope, C. (2000). Assessing quality in qualitative research. BMJ, 320(7226), 50–52.

Minichiello, V. (1990). In-Depth Interviewing: Researching People. Longman Cheshire.

Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic Analysis: Striving to Meet the Trustworthiness Criteria. International Journal of Qualitative Methods, 16 (1). https://doi.org/10.1177/1609406917733847

Petty, N. J., Thomson, O. P., & Stew, G. (2012). Ready for a paradigm shift? part 2: Introducing qualitative research methodologies and methods. Manual Therapy , 17 (5), 378–384. https://doi.org/10.1016/j.math.2012.03.004

Punch, K. F. (2013). Introduction to social research: Quantitative and qualitative approaches. London: Sage

Reeves, S., Kuper, A., & Hodges, B. D. (2008). Qualitative research methodologies: Ethnography. BMJ , 337 (aug07 3). https://doi.org/10.1136/bmj.a1020

Russell, C. K., & Gregory, D. M. (2003). Evaluation of qualitative research studies. Evidence Based Nursing, 6 (2), 36–40.

Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H., & Jinks, C. (2018). Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & quantity , 52 (4), 1893–1907. https://doi.org/10.1007/s11135-017-0574-8

Scarduzio, J. A. (2017). Emic approach to qualitative research. The International Encyclopedia of Communication Research Methods, 1–2 . https://doi.org/10.1002/9781118901731.iecrm0082

Schreier, M. (2012). Qualitative content analysis in practice / Margrit Schreier.

Shenton, A. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22 , 63–75.

Starks, H., & Trinidad, S. B. (2007). Choose your method: a comparison of phenomenology, discourse analysis, and grounded theory. Qualitative health research , 17 (10), 1372–1380. https://doi.org/10.1177/1049732307307031

Tenny, S., Brannan, J. M., & Brannan, G. D. (2022). Qualitative Study. In StatPearls. StatPearls Publishing.

Tobin, G. A., & Begley, C. M. (2004). Methodological rigour within a qualitative framework. Journal of Advanced Nursing, 48, 388–396. doi:10.1111/j.1365-2648.2004.03207.x

Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & health sciences , 15 (3), 398-405. https://doi.org/10.1111/nhs.12048

Wood L. A., Kroger R. O. (2000). Doing discourse analysis: Methods for studying action in talk and text. Sage.

Yilmaz, K. (2013). Comparison of Quantitative and Qualitative Research Traditions: epistemological, theoretical, and methodological differences. European journal of education , 48 (2), 311-325. https://doi.org/10.1111/ejed.12014

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5 Qualitative Research Methods Every UX Researcher Should Know [+ Examples]

Published: April 11, 2023

Have you ever heard the phrase, "the numbers don't lie?" Well, they don't lie per se , but qualitative research methods show that numbers don't always tell the full story.

Understanding how customers feel, think and criticize your company is crucial to improving your products and services. That's why it's important to include qualitative research during your feedback collection process.

In this article, we'll take a look at qualitative research methods in more detail.

Continue reading or jump ahead:

What is qualitative research?

Qualitative research approaches, 5 types of qualitative research methods, qualitative research method examples, qualitative research questions, qualitative research.

Qualitative research is a form of exploratory research that's designed to uncover the perceptions, motivations, and attitudes that drive consumer habits. Different types of qualitative research methods, like focus groups and in-depth interviews, help you make educated assumptions about your audience.

Qualitative research ultimately guides the creation of hypotheses, which can then be proved or disproved through quantitative research.

In other words, it compliments quantitative research when analyzing customer behavior , and the two give you a complete picture of your customer base .

The image below outlines the differences between qualitative and quantitative research, and how they meet in the middle to create a mixed methods strategy.

We'll explore this in more detail next.

Qualitative vs. Quantitative Research

While qualitative research describes consumer perceptions, attitudes, and trends, quantitative research records empirical data that confirms or rejects subjective findings. Qualitative data is descriptive and relays what customers are saying or thinking about your business. Quantitative data is numerical and represents undisputable events that occurred with the organization.

Quantitative research also generalizes data from large sample populations, while qualitative research typically uses smaller ones. That's because numerical findings are stronger when tested on a larger sample size.

Check out the video below from Nielsen Norman Group to learn more about the distinction between qualitative and quantitative research.

In general, quantitative research gathers and measures numerical data to offer narrow, focused results, while qualitative research gathers verbal and open-ended data to offer broader, big-picture results.

Mixed Methods Research

Mixed methods research is exactly what it sounds like. With this concept, researchers combine both qualitative and quantitative methodologies to gather data.

Here's an example of when both types of research are used together.

Mixed Methods: Quantitative vs. Qualitative Research Example

In the early 2000's, Samsung wanted to redesign its televisions . So, the company turned to ethnography reports to see how its consumers were currently using its products and similar ones made by Samsung's competitors.

Samsung found through this research that the majority of its TVs were turned off throughout the day, so they were viewed more like pieces of furniture for customers rather than electronics.

With that in mind, Samsung decided its next TVs would be visually stunning, with speakers that were hidden below the TV to give the product a sleeker, more modern design.

Here's where quantitative research came in. Researchers used feedback tools like CSAT and Likert scales to obtain quantitative feedback which showed empirical evidence supporting their new TV design.

Although all qualitative research shares a common goal, there are several types of research approaches you can use, as shown in the image below.

Let's break each one down.

Ethnographic Research

Ethnographic researchers enter the participants' natural environment to understand how they use a product. This provides context and cultural insights into the everyday lives of customers.

How It's Used

Similar to the Samsung example explained above, businesses typically use ethnographic research when trying to understand customer behavior .

If a company wants to create a new product or feature, researchers can observe how customers are currently using their products and record any points of friction found within the experience.

Narrative Research

Narrative research involves in-depth interviews and document analysis. Typically, one or two participants are interviewed over a long period of time — from weeks to months to years.

This creates a conclusive, individualized story that offers clear themes and insights into how personal goals influence customers.

Narrative research is particularly helpful when creating buyer personas and a customer journey map .

Since you're following the customer experience from start to finish, you can use this information to resolve pain points and optimize interactions for customer delight .

Case Study Research

During case study research, employees read several case studies to gain a deep understanding of a topic or theme. Since these are real examples, researchers can find similarities between their business and the case study.

Case studies are a useful tool for customer advocacy . If you conduct a case study on a customer who has succeeded using your product, you can publish that story to your website for other visitors to see.

That way, potential leads can read about another person or business who has faced a problem like theirs and use that information to find a solution.

Phenomenological Research

Phenomenological research combines a variety of research methods — interviews, observation, reading, and more — to help you describe a place, action, or process.

This description is based entirely on the perspectives of participants as it analyzes people who have first-hand experience with the activity.

One area where this type of research is useful is exploring how employees or customers feel about a particular company policy.

For example: Let's say your employees ask you to remove a "pointless" safety rule because they think it slows down their productivity when it's really in their best interest to keep it.

You can use your phenomenological research to educate employees on why that policy is important.

Grounded Theory Research

Grounded theory research goes a step beyond phenomenological research by uncovering explanations behind certain activities.

To develop a theory, this method involves interviewing large samples of customers and performing in-depth document research to better comprehend how consumers use products.

Grounded theory research is typically a long-term play. As your business gathers more information over time, you start to recognize unique trends regarding customer needs and goals.

Once you know why people are choosing your products, you can confidently create new products and features that encapsulate the core values that your customers are looking for.

Now, let's move on to the qualitative research methods you can use based on your approach.

Before we dive into the different types, let's back up to discuss what a qualitative research method is.

What is a qualitative research method?

Your qualitative research method will be informed by the qualitative research approach you're using.

The approaches we explored above outline how you can frame your qualitative research. Qualitative research methods highlight the specific activities you can implement to collect information.

For example: If you're conducting narrative research as your exploratory approach, you may use in-depth interviews and observations as your methods for data collection.

As shown in the image below, these are the five most common types of qualitative research methods.

We'll explore each below.

1. In-Depth Interviews

In-depth interviews allow you to ask people questions on a more personal level, one-on-one and typically face-to-face or over the phone. Interviews typically last anywhere from one to two hours and are meant to be conversational in nature.

Why This Works

The major advantage of this method is that it gives you the opportunity to dig deeper into your respondents thoughts, attitudes, and behaviors because of the level of intimacy it creates.

2. Focus Groups

A focus group is similar to an in-depth interview, but it includes more participants at one time — typically six to ten people. Everyone in a focus group is demographically similar in some capacity (e.g., by age, education level, etc.).

The major advantage of this method is that it allows you to create a forum for discussion among a group of people to learn more about how participants in your target audience feel about and interact with your products and services.

Survey methodology can be used in lieu of interviews and focus groups to gather information from customers.

Surveys are typically distributed in the form of questionnaires with a combination of close-ended, demographic questions and open-ended research questions on a particular topic.

The major advantage of this method is that it's less time-consuming than others. Plus, surveys allow you to gather information from a large population of customers quickly and effectively.

4. Observations

Observation research creates a detailed recording of your participants' actions. Through observation, researchers are paying careful attention to how people behave in a particular environment.

The major advantage of this method is that it facilitates a more natural and realistic data collection experience. Customers won't feel the pressures of a formal study and can instead simply behave as they normally would.

5. Secondary Research

Companies can draw relevant conclusions from secondary research data — like case studies, previous research findings, and other reference documents — to supplement a new or existing research study.

The major advantage of this method is that, well, you're letting someone else do the work for you. Instead of recreating the wheel, you're tapping into existing research to help analyze your target consumers.

Let's take a look at some of these qualitative research approaches and methods in action.

Here are a few examples of how business may use the qualitative approaches and methods that we discussed above.

Using Ethnography to Understand Your Target Audience

A clothing store wants to understand why its customer base is mostly men when it markets its products as unisex.

After performing an ethnographic study using the observation method, researchers discovered that unisex products aren't as appealing to women due to the shapeless fit and duller colors.

Now, the store can rebrand itself as a men's and women's clothing store and produce offers that better align with women's tastes.

Building Buyer Personas from Narrative Research

A start-up company selling baby products wants to build a buyer persona to better understand its target audience.

To do this, the company decides to record the lives of two individuals who fit into its market: a woman, 32, married with a newborn baby and a man, 36, married with three young children.

After conducting in-depth interviews with these participants for over two years, the company has a complete picture of every roadblock their customers face when raising a child.

Analyzing Customer Needs Based on the Grounded Theory Framework

A government agency wants to better support communities that have survived natural disasters.

After holding focus groups with several survivors, watching videos, and reading case studies on the topic, the agency realizes that these communities require more emotional support than physical support.

While donations are extremely beneficial, many of these families are traumatized by the experience and aren't sure how to restart their lives.

Now, the agency can put into place emotional support options for these people, such as free counseling and hotline services designed specifically for natural disaster survivors.

After understanding the benefits of qualitative research, you can start building questions to guide your team's research.

When asking qualitative research questions, it's important to ask effective questions that keep participants focused on the topic.

Below are the two types of questions you can ask when obtaining qualitative data: central questions and sub-questions.

Central Questions

This is the overarching question that guides your research. It identifies the main theme you're researching, the target audience, and any other information relative to the study.

Example: "How do you feel about our rewards program?"

Sub-Questions

Sub-questions complement the central question and focus on specific aspects of the overarching topic. These questions direct the participant to an individual detail that your team wants to know more about.

Example: "What type of rewards would you like to see in our loyalty program?"

While combining these two types of questions will give you an organized structure for obtaining data, your research will be useless if your questions are ineffective.

If you're not sure where to start, take a look at the next section to review the universal qualities found in excellent qualitative research questions.

Qualities of Good Qualitative Research Questions

Here are some best practices you should keep in mind when creating qualitative research questions.

The questions should be open-ended as this leaves more opportunity for participants to offer their own opinions rather than being constrained by preset answers.

Simply-Worded

Participants shouldn't have to work to understand what researchers are looking for. Make sure that the question is phrased simply and excludes any confusing jargon.

Offers Necessary Insights

As obvious as it might seem, the questions should bring in answers that will help you gain more information about the overarching topic. If a question is supplemental and not beneficial to your research, it's best to nix it.

Leveraging Qualitative Research Methods at Your Company

Qualitative research can offer a wealth of customer knowledge for your business. And it helps that qualitative research methods give customers the opportunity to express their motivations, perceptions, and attitudes about your products and services to you directly.

After all, the more you know about your customers, the easier it becomes to provide delightful experiences at every stage of the buyer's journey.

Editor's note: This post was originally published in August 2020 and has been updated for comprehensiveness.

Don't forget to share this post!

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Qualitative Research Methods: Types, Analysis + Examples

Qualitative research is based on the disciplines of social sciences like psychology, sociology, and anthropology. Therefore, the qualitative research methods allow for in-depth and further probing and questioning of respondents based on their responses. The interviewer/researcher also tries to understand their motivation and feelings. Understanding how your audience makes decisions can help derive conclusions in market research.

What is qualitative research?

Qualitative research is defined as a market research method that focuses on obtaining data through open-ended and conversational communication .

This method is about “what” people think and “why” they think so. For example, consider a convenience store looking to improve its patronage. A systematic observation concludes that more men are visiting this store. One good method to determine why women were not visiting the store is conducting an in-depth interview method with potential customers.

For example, after successfully interviewing female customers and visiting nearby stores and malls, the researchers selected participants through random sampling . As a result, it was discovered that the store didn’t have enough items for women.

So fewer women were visiting the store, which was understood only by personally interacting with them and understanding why they didn’t visit the store because there were more male products than female ones.

Gather research insights

Types of qualitative research methods with examples

Qualitative research methods are designed in a manner that helps reveal the behavior and perception of a target audience with reference to a particular topic. There are different types of qualitative research methods, such as in-depth interviews, focus groups, ethnographic research, content analysis, and case study research that are usually used.

The results of qualitative methods are more descriptive, and the inferences can be drawn quite easily from the obtained data .

Qualitative research methods originated in the social and behavioral research sciences. Today, our world is more complicated, and it is difficult to understand what people think and perceive. Online research methods make it easier to understand that as it is a more communicative and descriptive analysis .

The following are the qualitative research methods that are frequently used. Also, read about qualitative research examples :

1. One-on-one interview

Conducting in-depth interviews is one of the most common qualitative research methods. It is a personal interview that is carried out with one respondent at a time. This is purely a conversational method and invites opportunities to get details in depth from the respondent.

One of the advantages of this method is that it provides a great opportunity to gather precise data about what people believe and their motivations . If the researcher is well experienced, asking the right questions can help him/her collect meaningful data. If they should need more information, the researchers should ask such follow-up questions that will help them collect more information.

These interviews can be performed face-to-face or on the phone and usually can last between half an hour to two hours or even more. When the in-depth interview is conducted face to face, it gives a better opportunity to read the respondents’ body language and match the responses.

2. Focus groups

A focus group is also a commonly used qualitative research method used in data collection. A focus group usually includes a limited number of respondents (6-10) from within your target market.

The main aim of the focus group is to find answers to the “why, ” “what,” and “how” questions. One advantage of focus groups is you don’t necessarily need to interact with the group in person. Nowadays, focus groups can be sent an online survey on various devices, and responses can be collected at the click of a button.

Focus groups are an expensive method as compared to other online qualitative research methods. Typically, they are used to explain complex processes. This method is very useful for market research on new products and testing new concepts.

3. Ethnographic research

Ethnographic research is the most in-depth observational research method that studies people in their naturally occurring environment.

This method requires the researchers to adapt to the target audiences’ environments, which could be anywhere from an organization to a city or any remote location. Here, geographical constraints can be an issue while collecting data.

This research design aims to understand the cultures, challenges, motivations, and settings that occur. Instead of relying on interviews and discussions, you experience the natural settings firsthand.

This type of research method can last from a few days to a few years, as it involves in-depth observation and collecting data on those grounds. It’s a challenging and time-consuming method and solely depends on the researcher’s expertise to analyze, observe, and infer the data.

4. Case study research

T he case study method has evolved over the past few years and developed into a valuable quality research method. As the name suggests, it is used for explaining an organization or an entity.

This type of research method is used within a number of areas like education, social sciences, and similar. This method may look difficult to operate; however , it is one of the simplest ways of conducting research as it involves a deep dive and thorough understanding of the data collection methods and inferring the data.

5. Record keeping

This method makes use of the already existing reliable documents and similar sources of information as the data source. This data can be used in new research. This is similar to going to a library. There, one can go over books and other reference material to collect relevant data that can likely be used in the research.

6. Process of observation

Qualitative Observation is a process of research that uses subjective methodologies to gather systematic information or data. Since the focus on qualitative observation is the research process of using subjective methodologies to gather information or data. Qualitative observation is primarily used to equate quality differences.

Qualitative observation deals with the 5 major sensory organs and their functioning – sight, smell, touch, taste, and hearing. This doesn’t involve measurements or numbers but instead characteristics.

Explore Insightfully Contextual Inquiry in Qualitative Research

Qualitative research: data collection and analysis

A. qualitative data collection.

Qualitative data collection allows collecting data that is non-numeric and helps us to explore how decisions are made and provide us with detailed insight. For reaching such conclusions the data that is collected should be holistic, rich, and nuanced and findings to emerge through careful analysis.

• Whatever method a researcher chooses for collecting qualitative data, one aspect is very clear the process will generate a large amount of data. In addition to the variety of methods available, there are also different methods of collecting and recording the data.

For example, if the qualitative data is collected through a focus group or one-to-one discussion, there will be handwritten notes or video recorded tapes. If there are recording they should be transcribed and before the process of data analysis can begin.

• As a rough guide, it can take a seasoned researcher 8-10 hours to transcribe the recordings of an interview, which can generate roughly 20-30 pages of dialogues. Many researchers also like to maintain separate folders to maintain the recording collected from the different focus group. This helps them compartmentalize the data collected.
• In case there are running notes taken, which are also known as field notes, they are helpful in maintaining comments, environmental contexts, environmental analysis , nonverbal cues etc. These filed notes are helpful and can be compared while transcribing audio recorded data. Such notes are usually informal but should be secured in a similar manner as the video recordings or the audio tapes.

B. Qualitative data analysis

Qualitative data analysis such as notes, videos, audio recordings images, and text documents. One of the most used methods for qualitative data analysis is text analysis.

Text analysis is a  data analysis method that is distinctly different from all other qualitative research methods, where researchers analyze the social life of the participants in the research study and decode the words, actions, etc. 

There are images also that are used in this research study and the researchers analyze the context in which the images are used and draw inferences from them. In the last decade, text analysis through what is shared on social media platforms has gained supreme popularity.

Characteristics of qualitative research methods

• Qualitative research methods usually collect data at the sight, where the participants are experiencing issues or research problems . These are real-time data and rarely bring the participants out of the geographic locations to collect information.
• Qualitative researchers typically gather multiple forms of data, such as interviews, observations, and documents, rather than rely on a single data source .
• This type of research method works towards solving complex issues by breaking down into meaningful inferences, that is easily readable and understood by all.
• Since it’s a more communicative method, people can build their trust on the researcher and the information thus obtained is raw and unadulterated.

Qualitative research method case study

Let’s take the example of a bookstore owner who is looking for ways to improve their sales and customer outreach. An online community of members who were loyal patrons of the bookstore were interviewed and related questions were asked and the questions were answered by them.

At the end of the interview, it was realized that most of the books in the stores were suitable for adults and there were not enough options for children or teenagers.

By conducting this qualitative research the bookstore owner realized what the shortcomings were and what were the feelings of the readers. Through this research now the bookstore owner can now keep books for different age categories and can improve his sales and customer outreach.

Such qualitative research method examples can serve as the basis to indulge in further quantitative research , which provides remedies.

When to use qualitative research

Researchers make use of qualitative research techniques when they need to capture accurate, in-depth insights. It is very useful to capture “factual data”. Here are some examples of when to use qualitative research.

• Developing a new product or generating an idea.
• Studying your product/brand or service to strengthen your marketing strategy.
• To understand your strengths and weaknesses.
• Understanding purchase behavior.
• To study the reactions of your audience to marketing campaigns and other communications.
• Exploring market demographics, segments, and customer care groups.
• Gathering perception data of a brand, company, or product.

LEARN ABOUT: Steps in Qualitative Research

Qualitative research methods vs quantitative research methods

The basic differences between qualitative research methods and quantitative research methods are simple and straightforward. They differ in:

• Their analytical objectives
• Types of questions asked
• Types of data collection instruments
• Forms of data they produce
• Degree of flexibility

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• Chapter Five: Qualitative Methods (Part 1)

Every day you are confronted with the need to understand research methodology. In your work life, you are asked to compile and process data. Whether you are researching leadership techniques or analyzing sales statistics, you must be able to interpret the data you encounter. There is an everyday utility to qualitative techniques such as observation or interviewing. Imagine yourself as a new member of an organization. What are the informal rules of the organization? What is the culture of this work environment? Are there expectations other than the ones provided in the job description or by the supervisor? Over time, with keen observation and interview skills, a new organization member can uncover the answers to these and other questions. So, while the information contained in this section approaches qualitative methodologies from a scholarly perspective, the skills and techniques identified herein will help you understand human social action in a variety of situations.

• Chapter One: Introduction
• Chapter Two: Understanding the distinctions among research methods
• Chapter Three: Ethical research, writing, and creative work
• Chapter Four: Quantitative Methods (Part 1)
• Chapter Four: Quantitative Methods (Part 2 - Doing Your Study)
• Chapter Four: Quantitative Methods (Part 3 - Making Sense of Your Study)
• Chapter Five: Qualitative Data (Part 2)
• Chapter Six: Critical / Rhetorical Methods (Part 1)
• Chapter Six: Critical / Rhetorical Methods (Part 2)
• Chapter Seven: Presenting Your Results

One of the goals of quantitative research is to produce generalized knowledge about a communication event or phenomenon. Quantitative researchers ground their investigations in the scientific method in order to control or manipulate variables, reduce or eliminate researcher bias, and discover verifiable patterns of human behavior. The goals of quantitative research are to explain, predict, and control behavior. Qualitative research, in contrast, seeks to develop subjective understanding of communication phenomena. Rather than the experimental designs and survey instruments of quantitative researchers, qualitative researchers often seek to collect data in natural settings and rely on observations of and interviews with research participants to create data, which is not designed to produce quantifiable and generalizable results, but rather to produce in-depth understanding specific to particular situations. Although noticeably different from quantitative and rhetorical research designs, qualitative research methods are a popular and vital approach to the identification, understanding, and analysis of human interaction. In this chapter, we discuss the fundamental assumptions, philosophical traditions and salient attributes of qualitative research.

The Qualitative Worldview

Individuals engaged in qualitative research approach their projects from a different perspective than quantitative and rhetorical researchers. Even though all researchers share an interest in accurately reflecting social reality and in crafting an intellectual argument that is built on the foundations of valid data collection and observation, several assumptions are specific to qualitative research. Understanding these assumptions can help you better determine whether you need to use qualitative methods for the particular study in which you are interested.

Assumptions of Qualitative Research

Our knowledge of social reality is based on subjective interpretation.  Qualitative researchers assume that due to our limited perception and our individual experiences, our understanding of social reality is necessarily subjective. Due to this, qualitative researchers reject the realist worldview that postulates an objective, measurable reality. Instead, reality is a social construction, given life through  intersubjective  agreement – that is, the contours of reality are defined by general agreement between humans in the society. Another way to think of this is that reality isn't completely  objective  – existing externally from humans, but  subjective  – existing in the interpretations of humans. Concepts such as love, democracy, and friendship are difficult to quantify, and are often the result of negotiated understandings between pairs or groups of people. Therefore, for qualitative researchers, it is important to understand how individuals and groups subjectively understand their experiences.

Subjectivity, in regards to qualitative research, manifests itself in two ways. On one hand, there is the recognition that the participants in the research have their own unique way of interpreting and understanding events and their own social actions. For example, a researcher studying leadership would recognize that research participants, whether they are CEOs or workers, coaches or players, preachers or congregation members, have their own unique perspective on leadership. In order to fully understand leadership, a qualitative researcher would need to consider all, or at least as many as possible, of the various subjective understandings of leadership.

On the other hand, the researcher recognizes that he or she is the primary data collection instrument, and her or his subjectivity affects the study. Rather than utilizing a survey, specifically designed to reduce bias and maintain objectivity, a qualitative researcher, whether through observation or interviewing, filters all of the data through his or her own understanding. In this way, a qualitative researcher must recognize his or her subjectivity regarding the collection and analysis of data.

Research proceeds inductively . Induction is the process of moving from a series of specific observations to a general conclusion or theory. Unlike quantitative research, which often proceeds deductively from a general premise or theory to specific examples, qualitative research, through the gathering of subjective interpretations, seeks to develop general understanding through the analysis of the collected data.

For example, it is unlikely that qualitative research will begin with a theory, such as Inoculation Theory (a theory concerning how people resist persuasion), and then through experimental or survey designs, seek to validate and support the theory. In fact, it is quite the opposite. Qualitative researchers, interested in how people resist persuasion, might begin by asking participants for accounts of times when they have successfully resisted persuasive attempts. Qualitative researchers deliberately avoid beginning with the conclusion. After collecting these individual accounts from participants, researchers analyze the data in order to identify situational rules that then facilitate understanding of social action.

The goal of qualitative research is  understanding . Nineteenth century German philosopher Wilhelm Dilthey (2010), articulating the difference between the natural and the social sciences, stated that the former sought causes and effects while the latter sought  verstehen . Simply put,  verstehen  means understanding. One of the founders of sociology, Max Weber, elaborated on Dilthey’s work and stated that the purpose and method of the social sciences should be  verstehen . Weber (1962) believed that it was not possible to fully predict human social action. Therefore, rather than attempting to predict and control human behavior, qualitative social scientists should seek to understand social action. It is important to recognize that human social action varies immensely, and it would be difficult to identify social actions that are likely to be consistent from one person to the next and across a variety of circumstances. For example, humans would have a wide range of responses to an embrace from an acquaintance, an insult, slapstick humor, physical violence, or being ignored.

Researchers emphasize credibility, rather than validity/reliability . Many qualitative researchers use the word credibility rather than validity or reliability. This is not to say that qualitative researchers do not desire validity, but rather to recognize that currently validity and reliability are synonymous with the quantitative approach to research. The use of the term  credibility  is a deliberate choice and refers to the veracity and accuracy of the data collected. Essentially, qualitative researchers are creating an argument—an argument which claims that the conclusions derived from the qualitative research are an accurate reflection of social reality. For example, if a U.S. Senator were giving a speech, we might ask whether or not the speaker is credible and whether or not the information presented in the speech is credible. In much the same way, we might evaluate qualitative research by asking whether or not the researcher and the argument presented in the research are credible.

Knowledge is created through intersubjective agreement . Qualitative researchers believe that knowledge is built through intersubjective agreement. For example, a researcher investigating friendship development among college students realizes that his or her study is only one piece of the puzzle and that a similar study would likely reveal new elements or focus on different characteristics of friendship. It is through the sharing of this body of knowledge that understanding is built. In fact, it is the very process of how research participants collectively construct multiple understandings in which the researcher is interested. Participants define and construct understanding intersubjectively and researchers document this process, enter their findings into the public record through publication, and then jointly construct meaning with other researchers, other participants, and other publications. Participants then become co-researchers with the researcher. This process results in an intersubjective, rather than an objective, understanding of the social world.     

The social setting or context is an important element in understanding any communication interaction . Qualitative researchers believe that context is integral to understanding communication. Research often takes place within the natural setting of the participants. For example, a researcher conducting an ethnography of college wrestling would observe the participants at practice, meetings, and competitions, etc.—paying careful attention to the characteristics of the setting. So, why is the context so important? In the case of a wrestling ethnography, many contextual factors aid our understanding of the group. Is the coach new or a seasoned veteran? Does the program have a stellar reputation or is it struggling for respectability? Does the team have 15 members or 45? Does the program have a state-of-the-art practice facility? All of these distinctions can help facilitate the researcher’s understanding of a group in a way that differs from quantitative research involving a survey of 200 wrestlers.

The values of the researcher cannot be completely separated from the research . Qualitative research is a subjective endeavor. A researcher relies on his or her ability to accurately interpret the available data in order to make a valid argument regarding the phenomena under investigation. Because the researcher is the data collection instrument and the values of the researcher are present during the interpretation, extra effort must be made to ensure that the biases of the researcher do not diminish the quality of the interpretation.

In life, it is obvious that people often see what they want to see. If a politician is giving a speech, it is likely that supporters will interpret elements of the speech in a manner that is entirely different from the way that detractors interpret those same elements. Because of this, it is important that researchers recognize and acknowledge the role that their values play in the interpretation of the data and to ensure that their conclusions are built on fully substantiated and supported claims.

In summary, qualitative assumptions include:

• Knowledge of social reality is based on subjective interpretation;
• Research proceeds inductively;
• The goal of qualitative research is understanding;
• Researchers emphasize credibility;
• Knowledge is created through intersubjective agreement;
• The social setting or context is an important element in understanding any communication interaction; and
• The values of the researcher cannot be completely separated from the research.

These assumptions represent the worldview shared by qualitative researchers. Ultimately, decisions regarding methodology rest on the types of questions that the researcher wants to answer. If your goal is to  understand  a particular communication phenomenon in depth, qualitative methods are a good research choice for you.

The Traditions of Qualitative Research

While quantitative research has the firmly established tradition of the scientific method, qualitative research locates its roots in a variety of philosophical strains. Cultural studies, critical theory, ethnomethodology, and others have all contributed to the theoretical traditions of qualitative methodology. However, the three traditions to be discussed here are hermeneutics, phenomenology, and symbolic interactionism.

Hermeneutics

According to Schwandt (2001),  hermeneutics  refers “to the art, theory, and philosophy of interpreting the meaning of an object” (p. 115). The “object” under examination can take a variety of forms: a Black-Eyed Peas song, a conversation between friends, a commercial for the latest iPhone, or a Presidential State of the Union Address. Hermeneutists call these objects “texts,” and they serve as the data for a hermeneutic study. The process of interpreting meaning makes hermeneutic analysis so fundamental to qualitative research. This process goes beyond the  translation  of a text and involves an effort to  interpret  the text. We are engaged in the process of interpretation every day. For example, lawyers, judges, and politicians are constantly in the process of interpreting laws. An ongoing discussion in the United States is whether or not the Bill of Rights is a “living, breathing document,” thus necessitating new interpretation, or is an unchanging document that means the same today as it did upon its ratification in 1791.

Hermeneutics, or interpretation, as a scholarly practice traces its roots to ancient Greek society. However, it is in the area of biblical scholarship that the more recent foundation of hermeneutics rests. Biblical scholars must not only translate ancient religious documents, but must interpret them for a new time period. For example, during the Protestant Reformation, new interpretations of biblical passages strengthened the Protestant cause while shifting away from Roman Catholic interpretations of the text. This process of interpretation is important because it acknowledges that texts must be reevaluated and re-interpreted in order to ascertain applicability and relevance.

Modern hermeneutics, as developed by Dilthey (2010), Gadamer (1976), and Ricoeur (1981), moved hermeneutic analysis beyond the study of ancient texts to include the range of “texts” that we consider for analysis today. Texts can include a near limitless range of social actions—transcripts from an interview, a movie, Congressional proceedings, a commercial, etc. In order to properly understand a text, the interpreter must have an understanding of not only the text, but of the cultural and historical epoch from which it originates. What do we know about the whole of the text? What do we know about the author or authors of the text? What do we know about the time period in which the text was created? Remember, the charge for a hermeneutic researcher is to interpret the text, and the goal of the hermeneutic researcher is understanding. Scholars in this tradition believe that one cannot fully understand a text until one understands the range of forces involved in the creation of the text. In this tradition, the emphasis is on the relationship among the text, author, context, and the researcher.

Phenomenology

While the centrality of interpretation in hermeneutic scholarship marks an approach that is clearly divergent from quantitative research with its scientific method roots, it is with phenomenology that we see a deliberate rejection of quantitative social science and its focus on an objective, measurable reality. Phenomenologists deny the existence of a reality that exists independent of our perceptions. 

Phenomenology originated with the work of Edmund Husserl (1990) as he sought to develop a way of objectively studying subjective experiences. Husserl focused on understanding events or phenomena by understanding how people consciously experience those events or phenomena. Husserl’s form of phenomenology, known as  transcendental phenomenology , included carefully cataloguing all of the attributes of an item, such as democracy, and then bracketing, or setting aside, those attributes of democracy that are completely subjective—byproducts of culture and the perceptions of the person conducting the analysis. Therefore, if a researcher wanted to understand a concept such as  democracy , he or she would identify all of the essential characteristics of democracy. Husserl would then advocate that those items on our list of essential characteristics of democracy that are culturally situated (for example, there are aspects of current U.S. democracy that differ from how other countries define democracy) be bracketed or set aside. By removing our cultural assumptions from the list through the process of bracketing, we are left with those items that seem universally, rather than contextually, valid—the essential characteristics of democracy.

While Husserl was interested in bracketing out the culturally based characteristics of a phenomenon, his student, Alfred Schutz (1967), found that the cultural variations that manifest in individual interpretation of experiences are the most interesting facets of the phenomenon. Therefore, Schutz’s  social phenomenology  emphasizes the subjective interpretation of everyday experiences. According to Schutz, these types of localized understandings are represented by people’s values, beliefs, etc. He called these typifications. In summary, while Husserl encouraged us to set aside our biases, Schutz asked us to consider how and why our biases develop.

Phenomenology focuses on  intersubjectivity . One way to understand the phenomenological concept of intersubjectivity is to imagine a group of researchers independently studying a previously undiscovered tropical island. One researcher, who is able to study the island via helicopter, is able to chronicle those island characteristics viewable from the air. Another researcher studies the island from a submarine and is able to describe the island characteristics viewable from this undersea vantage point. Finally, a third researcher is able to walk around the island and study it from within, and is able to see the island from a different perspective than either the aerial or nautical researcher. When the three researchers get together to share their findings, they identify those areas where their data overlaps—thereby revealing the essential characteristics of the island and achieving an intersubjective understanding. This does not mean that the observations unique to each researcher are invalid, just that it is never fully possible for others to experience the world in exactly the same manner as someone else and that the process of understanding a phenomenon is a process that is both ongoing and contingent. In distinguishing between the phenomenological approaches of Husserl and Schutz, Husserl would focus on where the researchers overlap, while Schutz would be more interested in the unique observations of each of the researchers.

Stewart and Mickunas (1990), after noting the lack of consensus in defining phenomenology, stated, “one can characterize phenomenological philosophy as centering on the following basic themes: a return to the traditional tasks of philosophy, the search for a philosophy without presuppositions, the intentionality of consciousness, and the refusal of the subject-object dichotomy” (p. 5). In summary, phenomenology contributes to qualitative research with its recognition of subjective experiences and its goal of intersubjective meaning construction. Quantitative researchers use sophisticated surveys as measuring devices. In qualitative research, the researcher is the data collection device.

Symbolic Interactionism

The third tradition influencing modern qualitative scholarship is Symbolic Interactionism. The aim for researchers in this tradition is to ascertain how meaning develops. Humans use symbols (words, phrases, images, nonverbal gestures, etc.) to interact with one another. How is it that people are able to agree on common understandings for these symbols? According to Symbolic Interactionists like Mead and Blumer (1986), the cultural meanings that people attach to symbols develop through their interactions with members of their social network, mediated images in their environment, and social context in a larger sense. Through these shared symbolic understandings, people are able to make sense and interpret their experiences.

Symbolic Interactionism focuses on the interplay among mind, self, and society.  Mind  includes individual human thoughts, while  self  considers interaction with others.  Society  provides the context in which meaning is made possible. What each know, their stock of knowledge, is shaped by their experiences and their interactions within a societal network, and knowledge, in turn, impacts the societal network.

Even though people often successfully share meanings, it is important to remember that meanings are constantly under negotiation. While most might share a collective interpretation of the essential characteristics of a dog, the meanings of other terms, like  liberal  or  conservative , are constantly under negotiation. Your own political orientation, the political orientation of your social group, and the political orientation of your family members all shape your understanding of these terms. Additionally, other factors such as how distinct media outlets define liberal or conservative or how you feel about specific politicians influence and guide how you conceptualize these terms.    Over the course of the evolution of Symbolic Interactionism, key components developed to further explain the results of interaction among social groups. Significant symbols and significant others are two examples of essential characteristics of this approach to human social action.  Significant symbols  are those, that when used, elicit understanding among the social group. For example, others might interpret the use of an image of an eagle or an American flag pin on your lapel as representative of your patriotism. The term  significant others  refers to those whom most shape a person’s understanding of cultural symbols.

Consider a concept such as corporate branding—where a corporation hopes to build a specific connection between a symbol representing their company and their target audience. For example, Nike wants customers and athletes to immediately connect the swoosh on their logo with quality or performance. However, it is important to remember the roles social groups play in people’s interpretation of significant symbols like the Nike swoosh. Some, due to Nike’s lawsuits, might associate the swoosh with unfair labor practices or poor working conditions. This example serves to further demonstrate that cultural understandings are always contingent.

If one considers that these three philosophical traditions represent the foundation of qualitative research, the individual pillars of the foundation reveal themselves. From hermeneutics comes the centrality of interpretation and the identification of texts (in all their myriad forms) as fundamental elements of scholarly analysis. From phenomenology comes the recognition that everything a person understands about reality is filtered through her or his own individual perceptions and that we should strive for intersubjective understandings of reality. Finally, from symbolic interactionism comes the realization that how people experience reality is shaped by the shared symbolic meanings that arise from their social network, cultural group, or philosophical standpoint. All three of these foundations reject a realist ontology; that is, the idea that there is a single objective reality that we can know independent of our subjective interpretation. Elements from nearly all of the assumptions of qualitative research, interpretation, textual artifacts, subjective understanding, and contextual shaping  can be traced back to these pillars.

Attributes of Qualitative Research

Before proceeding to an in-depth examination of specific steps for initiating and conducting a qualitative research project, there are a few general attributes and elements of qualitative research to consider. In this section, the authors discuss the primacy of observation as an essential attribute for a qualitative researcher, the types of questions posed by researchers, the different forms of data common to qualitative research, the varieties of sampling, and ways to improve the accuracy of your qualitative findings.

Observation

Having established the relationship between subjectivity and qualitative research and having established that the qualitative researcher, unlike the quantitative researcher, is the primary data collection instrument, it is necessary to consider one of the primary means of data collection in qualitative research: observation. It is common in qualitative research for researchers to immerse themselves in the social environment under investigation. People naturally engage in the process of observation every day—seeing what the weather is like, paying attention to what friends or professors are saying, or attending a meeting with a campus organization. However, systematic, scholarly observation differs from casual observation.

One way to think of how qualitative observation differs from casual observation is to consider playing a game of Texas Hold ‘Em poker. When you get together and play with your friends for skittles or peanuts, you may or may not pay enough attention to see if your opponents are bluffing. Now imagine that you are playing Texas Hold ‘Em on ESPN for ten million dollars. Under those circumstances it is critical that players are able to read the behaviors of others and also have a high awareness of their own behaviors. This is similar to the characteristics of a scholarly observer. When conducting observations for research purposes, researchers need to be able to sort through, process, and accurately capture the variety of stimuli occurring simultaneously in the environment. Additionally, researchers need to be cognizant of their own interpersonal behaviors and consider how they are impacting those in the environment.

Observation plays a very specific role in  ethnography,  which is when the researcher immerses him or herself into the culture or group being investigated. It also takes a keen eye for observation when conducting focus groups or interviews. Oftentimes, during the early stages of a research project, the researcher might rely on observation to get a preliminary sense of the communication context of the research participants. In general, the observation continuum looks like this:

While the explanation of each type of observation is fairly straightforward, it is worth exploring how each differs from the other. When a researcher takes on the role of  complete observer , he or she is usually not already a member of the group under observation. When we study a group as an outsider, we call this adopting an  etic  perspective . Simply put, it would be difficult to carry out our day-to-day responsibilities as a group member and focus extensively on capturing detailed notes of our observations of the group. Consider a student on the campus of who is having difficulty understanding why the student organization in which he or she is a member (e.g., the Chess Club) is having trouble functioning effectively. This student might identify successful student organizations with the intent of sitting in as an observer in order to try to determine what those groups do that contributes to their success. The student might select a public relations student organization and attend several meetings, not with the intention of joining, but with the intention of identifying the social actions that help make the PR group a successful organization. By carefully and successfully documenting the procedures and activities of the public relations organization, the observer might be able to integrate these behaviors into her or his own organization.

On the other side of the continuum is the  complete participant , someone who is already a member of the organization that he or she wants to study. Imagine again that you are the president of the Chess Club, and you want to improve the functioning of your student organization. Because you are the president and have all of the responsibilities associated with that position, it would be very difficult to take time off from your regular duties to take extensive field notes about the Chess Club’s organizational procedures. When you study an organization from an insider’s perspective, as you are in this example, it is called taking an  emic  perspective . In this case, the complete participant wants to carry out his or her routine responsibilities and then, after the meeting, attempt to write detailed notes describing the activities and experiences of the meeting.

Before discussing the two perspectives that mark the middle areas of the continuum, it is necessary to highlight three salient points regarding differences between taking an  etic  perspective or an  emic  perspective.

• Although complete observers may bring a fresh set of eyes and be able to focus exclusively on the act of observing, they may find that access is limited and acceptance of their presence is not guaranteed.
• Although complete participants have the advantage of understanding the history, rituals, and jargon of the organization, their pre-existing biases may greatly cloud their interpretation of events.
• Both types of observers must pay considerable attention to the concept of trust—complete observers, if the participants are aware of his or her presence, may have difficulty gaining the trust of the group and getting them to behave as they naturally would (consider the Hawthorne effect that states that people behave artificially when they know that they are being observed). Complete participants may begin with the trust of the participants, but will likely find themselves navigating a difficult path, particularly if they become aware of behaviors and activities that portray some members of the group in a negative light.

So what is the difference between an observer-as-participant and a participant-as-observer? A few years ago, a colleague was doing an ethnographic study of the emergency room in a large hospital. She had no training in the medical profession. She received permission to conduct observations and interviews over the course of several months. She began the study as a complete observer. However, over the course of her ethnographic study, she had multiple experiences that caused her to shift from complete observer to an observer-as-participant role. On one occasion, due to shortages on the staff, she was asked to hold a patient’s leg in place in order for the doctor to attempt to set the broken leg prior to putting it in a cast. Needless to say, the colleague was not expecting to play any kind of active role in the hospital emergency room other than active observation. So, an observer as participant is when an individual maintains the primary role of observation, but on occasion is asked to participate. Another example is when other professors visit your classroom in order to observe and evaluate your professor or teaching assistant. In this case the primary role is the observation, but in some circumstances the observers find themselves participating in class activities such as discussion or role-playing. Now imagine that you are a nurse in an emergency room who has been asked by administration to document communication patterns in the emergency room and recommend improvements. The participant-as-observer still has the primary responsibility of being a nurse in the emergency room, but he or she might also have specific time in meetings or every hour or so to document and reflect on observations. In this way she/he fulfills the primary role of nurse, but also is able to allocate time to observation and analysis on the side.

It is important to determine which observation role is best suited for your research. You must consider whether you are an insider or an outsider for the organization. You must then determine if you will be taking a covert (undercover) role or a more overt (out in the open) role. Regardless of the type of observation in which the researcher engages, specific and systematic expectations for data gathering and analysis govern your research. The role that you take impacts the type of data that you are able to collect.

Research Questions, Seldom Hypotheses

Qualitative research proceeds inductively—beginning with a specific group or a specific question and then gathering data in order to lead to a general explanation or perhaps even a theory. Qualitative researchers are seldom engaged in testing existing theory in the same sense that quantitative researchers are. Therefore, qualitative research relies on broad research questions asking “how” or “what” rather than testable hypotheses that make clear predictions. Consider the following sample research questions from three different qualitative studies.

RQ1: In what ways are employees’ constructions of mistreatment in the workplace muted or privileged?  RQ2: What are the processes that silence or encourage discussion of mistreatment by employees? (Meares, Oetzel, Torres, Derkacs, & Ginossar, 2004, p. 9)

RQ1: What are the components of high self-esteem for the women in the study? RQ2: How do they say they manage the construction and maintenance of high self-esteem in their lives? (DeFrancisco & Chatham-Carpenter, 2000, p. 77)

RQ1: How do disabled organizational members experience and negotiate organizational assimilation? (Cohen & Avanzino, 2010, p. 278)

While these three qualitative studies clearly follow the pattern of asking “how” or “what” questions, it is important to remember that, in general, there is more flexibility regarding the normative presentation of qualitative research. In some cases, such as the research of Wong and Goodwin (2009), because there was already an existing body of evidence on which to base their research, they proffered hypotheses with their qualitative study on marital satisfaction. Their hypotheses included:

H1: Bonding and the interactions between the spouses would be more important in individuals’ evaluation of marital relationships in modernized societies where independence is valued. H2: Relationships with other family members would be more important in the evaluation of marital relationships in societies where interdependence is valued. H3: Financial security would be a more important factor in marital satisfaction in less modernized settings. (Wong & Goodwin, 2009, p. 1014)

Wong and Goodwin gathered their data through in-depth qualitative interviews, but due to the large body of existing scholarship on marital satisfaction, they were confident in presenting hypotheses. However, it is necessary to point out that while hypotheses in qualitative research may exist, they are rare.

To further demonstrate the variation in qualitative research, some research studies may eschew research questions altogether. In these cases there is often a research purpose stated prior to describing the methods, but this purpose may take the form of a tentative statement rather than a research question. For example, Weinstein (2007) used field observations, interviews, and written documents to explore how inner city youths used writing (poetry, lyrics, etc.) to negotiate gender and sexual identity. She states, “I hope to contribute to the ongoing work done by researchers on adolescents’ and young adults’ uses of written and oral composition to find workable identities in the midst of multiple and shifting social contexts” (Weinstein, 2007, p. 30). In another case, Hundley and Shyles (2010) studied teenagers’ perceptions of technology and, rather than asking a research question, they simply stated, “this research continues the line of inquiry by listening to teenagers and gaining a perspective on what they think about emerging digital technologies and the functions various devices serve in their lives” (p. 418).

Thus, variation exists regarding the presentation of research goals in qualitative research. Goals may range from general purpose statements to specific research questions. Although hypotheses are rare, and research questions and research statements are more typical in qualitative research, one must remember that regardless of the approach, the methodology must be in the service of the overall research purpose.

Types of Data in Qualitative Research

The data for qualitative research takes many forms. Interviews and focus groups provide responses to carefully designed questions. Observation and ethnography provide detailed notes of the research setting. Participant responses or observation events may range from brief, specific responses to detailed, descriptive stories. A truly extensive ethnography, for example, might combine detailed field notes, descriptive stories, and specific responses to field interview questions. Stories, field notes, and interview/focus group responses are all valid forms of qualitative research data.

Stories.  Some qualitative techniques, such as narrative analysis, seek to elicit stories from the research participants, while in other cases, like interviews or focus groups, stories may arise naturally over the course of the research. Fisher (1984) said that it is natural for humans to communicate using stories. It is not hard to imagine the range of situations in which stories may either be elicited or arise spontaneously. Imagine an interview question where the researcher asks, “tell me about a time when you experienced conflict with a co-worker?” Or, consider doing research on U.S. wedding rehearsal dinner rituals. One can imagine the richness of the stories naturally arising in that setting. Qualitative research offers details and descriptions that are richer and more in-depth than quantitative research—the collecting of stories is a perfect way to capture the richness of our social activity.

Field notes . Whether one is observing a focus group, an emergency room, or the proceedings of a student organization meeting, field notes are a necessary tool for capturing the social activity as it unfolds. If the researcher is conducting an ethnography, and is involved in the act of cultural immersion, the observational field notes provide the data for the study. Field notes are a record of the activities of the participants of a study. The field notes are a written log of the researcher’s observations. Perhaps you like to go to the mall and watch the people as they come and go. Even with a good memory it is doubtful that you would be able to remember more than one or two interesting points if asked about it the next day. It is for this reason that detailed field notes, which describe the setting and participants in real time, are the best way of documenting a researcher’s time in the social environment.

For an ethnographer, the field notes are the data that allow the researcher to develop a credible argument in the final report. For a researcher observing a focus group, field notes enable the researcher to note the physical setting of the focus group or to chart how interaction proceeds over the course of the focus group. One of the most common ways to set up your field notes is to divide your page from top to bottom down the middle. On the left side of the page, the researcher should include specific observations, while on the right side of the page, the researcher should include tentative questions or concepts or future ideas. It is always important to also include the date, time, and location of the observation—and perhaps even a map of the research setting.

A good student activity is to select a location—the union, a class, a restaurant, etc.—and practice taking your own field notes. Just spend 30 minutes observing the location and see how accurately you are able to capture the setting and the ongoing interaction among the participants.

Consider the following example of field notes from observation of a graduate class:

In-depth interviews & focus groups.  Quite a bit of qualitative data is neither collected using field notes nor involves a detailed story. Much of the data follows the natural give and take of everyday conversation. Whenever possible, an audio recorder is a useful tool for capturing participant responses to interview questions. Open-ended responses that are not as extensive as a detailed story are very common in qualitative data. If brief, closed-ended responses are the type of data you need, you probably want to consider a quantitative survey. However, if you are interested in understanding how and why participants engage in certain activities or adopt certain values, qualitative interviewing will likely provide you with the type of data you need.

Stories, field notes, interview and focus group responses, and field notes are three common forms of data in qualitative research. All researchers are interested in producing the most accurate and valid conclusions from their data. Prior to and during the research process, there are choices the researcher can make to strengthen his or her results. The choices are rooted in a process called  triangulation , which means you may choose multiple ways to collect data or multiple methods to explore the answer to your research question/s (Denzin, 2006).

Sampling Characteristics

Selecting the participants for a qualitative study often relies on a very deliberate process. Whereas quantitative research improves its accuracy through random sampling that is representative of the population to which it seeks to extend its results, qualitative research, with its emphasis on context and focus on understanding, will generally use a  purposive  non-random sampling strategy, rather than a random, sampling process. Once again, the fact that qualitative research proceeds inductively (starting with a specific group or setting), rather than deductively, reinforces the necessity of purposive sampling practices. If a researcher wants to observe and understand the communication practices at a large retail store, he or she would purposely select a retail store as the setting for the study. According to Schwandt (2001), qualitative samples “are chosen not for their representativeness but for their relevance to the research question, analytical framework, and explanation or account being developed in the research” (p. 232). 

Another characteristic of qualitative research samples concerns sample size. Because qualitative research focuses on understanding rather than generalizations, the size of the sample is typically much smaller than a sample for a quantitative survey. For example, consider the amount of time it takes to set up, conduct, and transcribe ten average length interviews compared to an on-line survey that automatically compiles the data and uploads it into a statistical program. Also, if a researcher wants to study the large retail store with many departments, it is easy to imagine the amount of time necessary to complete a thorough ethnography. Even if the researcher only chooses to focus on a single department within a retail store, observing different shifts and different workers would take a considerable investment of time. Qualitative samples are both purposefully selected, to meet the research objective, and deliberately small, to be manageable for the researcher.

The Importance of Triangulation

All researchers seek to produce an accurate or credible account of the phenomenon under investigation. Researchers have a variety of options to improve the credibility of their studies. Triangulation is the process of using two or more types of evidence to provide a more clear and accurate interpretation of the data. Triangulation takes multiple forms from researcher triangulation to data triangulation. The basic premise behind triangulation is that if the multiple data sources converge, validity/credibility has been enhanced. We will briefly discuss several of the more popular forms of triangulation.

Multiple methodologies . This type of triangulation involves the researcher or researchers using multiple techniques to gather the data. Suppose that a researcher wants to study the communication practices of a local restaurant. One of the ways that the researcher might collect data is by interviewing the employees of the restaurant. The results of the interviews might paint a very accurate picture of restaurant activities. However, the researcher might also want to observe the restaurant as the social actors engage in their day-to-day activities. The idea behind triangulation is that the data collected from the interviews and the data collected from the observations of the restaurant, when combined, paint a more complete and accurate picture of the restaurant than either one of the methods alone. Of course, a researcher could also include a third method, focus groups, in an effort to corroborate the conclusions drawn from the interviews and the observations. Using multiple methodologies for triangulation does not have to be limited to qualitative methods. For example, it is very common for a researcher to conduct interviews in order to gain a basic understanding of a concept and then use that information to create quantitative surveys to distribute to a larger sample. The goal is to create the most credible interpretation of the data, and triangulation of methods is one way to improve the accuracy of a study.

Multiple researchers . This type of triangulation involves multiple researchers gathering data on the same subject. In the example regarding the ethnographic study of a retail establishment, it is easy to see how a research team would have an easier time collecting observations than an individual researcher would. It is not just that multiple researchers can spread out and cover more ground, thereby creating a more fully realized picture of the organization, but also that multiple researchers increase the chance of accurately capturing all of the activities occurring when viewing the same event. Think of all of the activities going on during a typical organizational meeting—multiple researchers would be able to capture a fuller spectrum of social activity in less time than just one researcher. Additionally, multiple researchers contribute to the development of intersubjective understanding. Multiple researchers can mitigate some of the biases of each researcher, helping to avoid reaching a premature conclusion or being overly subjective.

There are other forms of triangulation, such as multiple research settings (observing at different times or in different places) or multiple disciplinary approaches (one observer versed in organizational communication and another versed in organizational behavior). These forms of triangulation are not mutually exclusive; researchers can combine, and often do combine, a variety of these approaches.

General Strengths and Weaknesses of Qualitative Research

Perhaps the greatest strength of qualitative research is the sheer amount of depth it can bring to our understanding of social action. Qualitative data can capture many of the complexities of human interaction that are unable to be uncovered through a quantitative survey. Because it proceeds inductively, it is both strong at discovering new phenomena and at generating theories of human behavior. Qualitative data collection often occurs in the participants’ natural environment, improving the ecological validity of the study. As long as the researchers are able to overcome the Hawthorne effect, the data collected should reflect actual behaviors in ways that self-reported surveys or laboratory studies are unable to reflect. Finally, qualitative researchers allow the participants to tell their own stories rather than reducing the stories to numbers.

Qualitative research also has obvious weaknesses because the researcher is the data collection instrument, so the quality of the data is only as good as the researcher. Has the researcher collected enough data to paint an accurate picture? Has the researcher attempted to minimize individual bias to the fullest extent? These concerns represent just a few of the problems that could result from the subjective nature of qualitative research. Qualitative research is not good for generalizing results to a larger population and it is not good for examining causal relationships. There is also a considerable investment of time associated with this type of research.

5 Types of Qualitative Research Methods

Qualitative research is the process of acquiring data by studying subjects in their natural habitat. The focus is on understanding the why and how of human behaviour in situations, and is defined as a scientific research method to obtain non-numerical data.

Qualitative research is subjective in nature: • Methods are designed to understand the lives of participants. • The process is maintained on neutral lines without placing judgement on individual responses. • Focus areas are cultures, societies and individuals.

Types of Qualitative Research methods:

1. Ethnography Ethnography, one of the most popular methods of qualitative research, involves the researcher embedding himself or herself into the daily life and routine of the subject or subjects. Either as an active participant or an observer, the researcher experiences their customs, traditions, mannerisms, reactions to situations etc. first hand, sometimes for years. Geographical constraints could be a hindrance for the researcher.

Example of application : This on-the-field method can help companies in assessing how consumers use certain products or services, and accordingly develop new products or revamp existing products.

2. Narrative In the Narrative method of qualitative research, the researcher gathers data or facts from one or two subjects through interviews, documents etc. over a period of time. Based on a theme, these are then pieced together (not necessarily in the same sequence) to derive answers and suggestions.

Example of application: A business can use this method to understand challenges faced by their target audience that can in turn be utilised for innovation and development of products.

3. Phenomenology The Phenomenology qualitative research method is used to study an event or activity as it happens, from various angles. Using interviews, videos, on-site visits etc., one can add on to existing information using perspectives and insights from the participants themselves about the activity or event. It is primarily an experience or perception based research method.

Example of application : Universities can rely on this method to understand how students make their choices about applying to universities/colleges.

4. Grounded Theory Grounded theory starts with a question or collection of data. Through systematic data collection and analysis, repetitive ideas or elements are coded, and codes are grouped or categorised. New theories may be formed based on these categories.

Example of application : A product-based company can use this method to understand how their customers use their products or individual features of their product or products.

5. Case study The case study method is used to gather in-depth and detailed information about a subject, which could be any entity, organisation, event or something larger like a country. The nature of this qualitative research method can be explanatory or exploratory.

Example of application : For a business, case studies are a useful tool to formulate strategies, understand influences, devise new methods etc.

With open-ended questions, qualitative research methods produce results that are descriptive and inferences that are useful in breaking down complex problems into simpler components. The onus is on the researcher – he or she can change the course of the research based on the responses from or observations of the subjects.

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Five qualitative approaches to inquiry.

1. Narrative research

2. Phenomenology research

3. Grounded theory research

4. Ethnographic research

5. Case study research

VIEW APPROACH CompariSON

The Author Behind the Five Approaches

John W. Creswell , PhD is an Professor of Family Medicine and Co-Director, Michigan Mixed Methods Research and Scholarship Program at the University of Michigan. He has authored numerous articles and 27 books on mixed methods research, qualitative research and research design. While at the University of Nebraska-Lincoln, he held the Clifton Endowed Professor Chair, served as director of a mixed methods research office, founded the SAGE journal, the Journal of Mixed Methods Research , and was an Adjunct Professor of Family Medicine at the University of Michigan and a consultant to the Veterans Administration health services research center. He was a Senior Fulbright Scholar to South Africa in 2008 and to Thailand in 2012. In 2011 co-led a national working group on mixed methods practices at the National Institute of Health, served as a Visiting Professor at Harvard’s School of Public Health, and received an honorary doctorate from the University of Pretoria, South Africa.  In 2014 he was the President of the Mixed Methods International Research Association.  In 2015 he joined the staff of Family Medicine at the University of Michigan.

Titles by Best-selling Author John W. Creswell

Qualitative Inquiry and Research Design

Research Design

Designing and Conducting Mixed Methods Research

30 Essential Skills for the Qualitative Researcher

A Concise Introduction to Mixed Methods Research

11 Types of qualitative research marketers navigate every day

Types of qualitative research methods, when to conduct qualitative research, get the best of both worlds with attest market research platform.

Is your marketing or product development a bit weak and under the weather, or isn’t it as punchy as it used to be? Qualitative research might just be the pick-me-up it needs. Now, not just any type of qualitative market research (it’s not some magic cure-all). You need to pick the right type of qualitative research — and we’re here to help you do that.

But what you need to know about qualitative research at its core, is that it’s about exploring the qualities and nuances of human behavior and preferences. Using discussions, observations, and analysis, you try to uncover not just what people do, but why they do it.

Conducting qualitative research provides you with rich, detailed feedback that gives depth to – and compliments – quantitative research, and can help you formulate direct actions to take. Here’s which qualitative methods we’ll be exploring today.

• Focus groups
• Observation
• Content analysis 
• Narrative analysis
• Historical records management and case studies
• Ethnographic research
• Phenomenological research
• Grounded theory method
• Action research

1. Qualitative research surveys

Surveys are great for tapping into the minds of your audience: you can ask direct questions to gather feedback on everything, in a variety of formats.

With the flexibility to reach a broad audience and the ability to tailor your questions for specific insights, surveys are one of the most used tools for gathering qualitative data at scale, and in record speed.

• Collect feedback from a wide range of participants quickly.
• Tailor surveys to explore various aspects of consumer behavior, from product preferences to brand perception.
• Compared to other qualitative methods, surveys are relatively low-cost and can be distributed widely with minimal resources.

Challenges and solutions:

• Formulating questions that get deep, meaningful responses can be tricky. Focus on open-ended questions and avoid leading or biased phrasing.
• Keeping respondents interested and encouraging thoughtful responses is tricky. Offer incentives and ensure the survey is quick and clear to boost engagement and completion rates.
• The pile of qualitative data from open-ended survey responses can be a lot to work through, xo make sure you’re prepped for your qualitative data analysis.

When to use:

Use surveys to explore consumer sentiments, identify unmet needs and pain points, and evaluate what drives brand loyalty.

Send out survey questions and collect written answers or even video responses with Attest . Our platform takes care of everything, from survey templates to get you started, to best-in-class research advice to help you run truly great research.

See how qual research with Attest works

You can get high-quality video responses from your target audiences with Attest, and our team of research pros is on hand to help you run awesome research

2. Interviews

If you want to go deep, and not necessarily get a lot of data from different participants, interviews are your thing. By sitting down for a one-on-one with people from your target audience you can gather detailed feedback and personal stories

• You can follow the conversation wherever it leads, asking follow-up questions that bring out detailed or surprising insights.
• Human-to-human interactions can lead to more genuine responses, giving you a clearer picture of your audience.
• Interviews take a lot of time to conduct and analyze. Using transcription software and focusing your questions can speed things up.
• People might tell you what they think you want to hear. Make sure you create a comfortable setting and assure anonymity to encourage brutal honesty and fight bias.
• Data from interviews can be hard to compare. Sticking to a set of core questions while allowing for (controlled) personal exploration can help.

Use Interviews for qualitative research when developing new products or features to deeply understand user needs and reactions, and for branding or campaigns to gather stories and emotions that tie people to your brand, enriching your next marketing initiative.

3. Focus groups

Learn to read the room. Focus groups bring together a small group of people from your target market to discuss their opinions and experiences regarding your product or service. The setup of these groups often encourages participants to share their thoughts and ideas.

• Bringing together a variety of viewpoints and hearing how they compare to each other helps you understand the nuances of your target audience.
• Group discussions can lead to surprising angles and new insights into consumer attitudes and perceptions that individual interviews may not capture.
• Participants might sway towards consensus opinions. Encouraging open dialogue and using a skilled moderator can help avoid this. And make sure your group is diverse enough as well.
• Individuals can be overlooked in group settings. Feel like some voices are overpowering? Complement focus groups with one-on-one interviews for deeper insights.
• Organizing focus groups is pretty resource-intensive. Virtual focus groups or streamlined in-person sessions are more flexible.

Use focus groups for brand perception studies to delve into group discussions about your brand and for concept testing to gather immediate reactions to new product ideas, packaging, or marketing strategies.

4. Observation

Watching how people interact with your product or service in their natural environment (in person or through video recordings), without interference, is a great way to get real-life insights into user behavior, preferences, and potential improvements that might not be revealed through direct questioning.

• Beat assumptions and get a contextual understanding of how people interact with your product or service in real-world settings.
• Body language and other non-verbal signals can tell you a lot about how consumers feel when handling your product.
• the presence of an observer might make people change their behavior. Unobtrusive methods like video recording can help avoid that.
• Observers might interpret actions through their own bias. Make sure they are well-trained to avoid this, and that you work with multiple observers to compare interpretations.
• Translating observations into actionable data can be challenging. Structured observation guides and analytical frameworks can streamline your analysis.

Use Observation for user experience research to see how people interact with your product in real settings and for environmental impact studies to understand how different environments influence consumer behavior towards your brand.

5. Content analysis 

The words, images or videos related to your brand or product that people create and share tell a story. With content analysis, you collect all these elements and try to find themes, patterns or issues that stand out.

• You don’t have to worry about getting brand-new data in, which also makes it a more cost-effective and sometimes faster qualitative research method.
• With social listening and content analysis, you can identify emerging trends early in. All you need to do is really zoom in.
• The amount of available content is probably going to be overwhelming, but there are plenty of software tools for sentiment analysis out there that do the heavy lifting for you.
• Unhappy customers might be louder than the happy ones, so the content might not represent the broader audience. Balance your content analysis with direct research methods like surveys or interviews to mitigate this bias.

Use content analysis for uncovering insights into brand perception and evaluating the impact of marketing campaigns on public sentiment through social media content analysis.

6. Narrative analysis

Narrative analysis delves into the stories people tell about their experiences with your product or service. It focuses on understanding the sequence of events, the context, and the emotional journeys described by consumers.

• Unpacks the emotional journey and personal experiences of consumers, offering a rich understanding of their relationship with your product or service.
• By analyzing stories, you capture not just the facts but the context around consumer decisions and experiences, revealing deeper motivations.
• Stories often reflect broader cultural and social influences, helping you see how these factors impact consumer behavior.
• Personal biases can influence how narratives are interpreted. Establishing a clear analytical framework and involving multiple analysts can reduce bias.
• Narrative analysis can be detail-oriented and time-consuming. Using software to assist in data coding and thematic analysis can streamline the process.
• It can be challenging to ensure that the narratives collected are directly relevant to your research questions. Carefully designing the prompt and selection criteria for participants can help focus the stories gathered.

Use narrative analysis to map out detailed consumer journeys from first awareness to loyalty and to craft compelling brand stories that resonate deeply with your audience.

7. Historical records management and case studies

This method involves analyzing existing documents and records related to your market or industry, and conducting case studies on specific examples within your field. You look at historical trends, previous campaigns, product launches, and customer feedback over time, providing a context for current market dynamics and guiding future strategies.

• Offers a perspective on how consumer behaviors and market trends have evolved, giving you context for current data.
• You can measure the impact of changes or interventions tend to make in your marketing strategy or product development.
• Historical records may be scattered or difficult to access, so digitize records and maintain a centralized database now for future researchers.
• Ensuring that historical data is still relevant to current contexts can be challenging, so regularly update your data collection and analysis methods to reflect current market conditions.

Use historical records management and case studies for analyzing long-term market trends, assessing the effectiveness of marketing campaigns over time, and understanding the evolution of product life cycles influenced by consumer preferences.

8. Ethnographic research

Ethnographic research immerses you in the everyday lives of your target audience, observing them in their natural settings to understand their behaviors, rituals, and the social context of product usage. This gives you culturally grounded insights into how and why your product fits into consumers’ lives.

• By observing people in their natural environments, you get to see how they genuinely interact with products or services, unfiltered by self-reporting biases.
• You get detailed descriptions of people’s lives and interactions, and much more nuanced insights than numbers and charts.
• You’ll need significant time in the field and enough resources to do it right. Streamlining focus areas and using digital tools for data collection can help manage the workload.
• Immersion in a community or culture can lead to biased perspectives. Regular reflection sessions and involving multiple researchers can help maintain a balanced viewpoint.

Use ethnographic research to understand how user environments and cultures affect product use, tailor offerings for specific markets or cultural groups, and innovate with designs centered on real-world user behavior.

9. Phenomenological research

Phenomenological research focuses on the lived experiences of individuals regarding a particular phenomenon. Through in-depth interviews and discussions, you gather detailed personal accounts, looking for the underlying meanings and emotions attached to experiences with your product or service.

• It centers on the lived experiences of users, giving you a true-to-life image of understanding their needs, desires, and motivations.
• Captures the essence of consumer experiences, delivering authentic insights that can guide more empathetic and effective marketing strategies.
• The depth of phenomenological data can make analysis challenging. Working with thematic analysis and seeking expert advice can make it more manageable.
• Finding participants willing to share deeply personal experiences may be difficult. Offer assurances of confidentiality and create a safe, respectful environment.

Use phenomenological research to dive deep into the emotions and experiences of new market segments, refine user experiences for greater satisfaction, and create brand messages that forge stronger emotional connections with your audience.

10. Grounded theory method

The grounded theory method starts with data collection without a predefined hypothesis, allowing theories to emerge from the data itself. Through continuous comparison of data from interviews, surveys, or observations, you develop a theory that explains a particular aspect of consumer behavior or market trends.

• Exploring data without preconceived theories is ideal for uncovering fresh insights and new perspectives on consumer behavior.
• Based on the data, you can develop theories that explain patterns and relationships within your market, setting up a strong foundation for strategic decisions.
• As data collection and analysis proceed in tandem, you can refine your research focus based on emerging insights, ensuring the relevance and depth of findings.
• The open-ended nature of grounded theory means you’ll get piles of data. Using software for data management and employing selective sampling techniques to focus the research.
• The iterative process of coding and recoding data to develop a theory is complex. Training in grounded theory methods and regular team discussions can help clarify the process.

Use the grounded theory method to innovate products, tackle complex consumer issues, and craft strategies that deeply align with consumer preferences and behaviors.

11. Action research

Action research is a participatory method where researchers work alongside participants to identify and solve problems or improve practices. In the context of market research, it could involve collaborating with consumers to co-create solutions or enhance product design.

• Findings and insights can be applied in real-time, allowing for fast adjustments to products, services, or marketing strategies.
• Active involvement from participants, leads to a deeper engagement with your brand and a sense of ownership over the solutions developed.
• Balancing the input and engagement of participants without overwhelming them can be challenging. Set clear expectations and provide structured feedback.
• The focus on immediate solutions might overlook deeper, underlying issues. Supplement with other qualitative methods to provide a more comprehensive understanding.
• The cyclical nature of action research, with its continuous cycles of planning, acting, observing, and reflecting, requires dedication and flexibility. Agile project management techniques can keep the project on track.

Use action research to develop products informed by user feedback, enhance customer experiences through targeted improvements, and strengthen relationships with communities or stakeholders through collaborative engagement.

Conduct qualitative research when you need in-depth understanding of consumer attitudes, feelings, or behaviors—areas where quantitative research’s numbers and statistics can’t provide the full picture.

Qualitative research is best used in tandem with quantitative research – they really do compliment each other. You can use qualitative research to help inspire you at the beginning of a project, or to flesh out ideas that emerge during preceding quantitative research.

It’s especially useful for exploring new concepts, enhancing product development, or deepening brand engagement, complementing quantitative data by adding context and depth to the insights gained.

With Attest’s market research platform, you can seamlessly blend qualitative and quantitative data, giving you the insights you need for smarter marketing and better product development. See how Attest is helping businesses in a variety of industries to better understand their audiences.

Andrada Comsa

Principal Customer Research Manager 

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• Open access
• Published: 29 May 2024

Exploring the use of body worn cameras in acute mental health wards: a mixed-method evaluation of a pilot intervention

• Una Foye 1 , 2 ,
• Keiran Wilson 1 , 2 ,
• Jessica Jepps 1 , 2 ,
• James Blease 1 ,
• Ellen Thomas 3 ,
• Leroy McAnuff 3 ,
• Sharon McKenzie 3 ,
• Katherine Barrett 3 ,
• Lilli Underwood 3 ,
• Geoff Brennan 1 , 2 &
• Alan Simpson 1 , 2  

BMC Health Services Research volume  24 , Article number:  681 ( 2024 ) Cite this article

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Body worn cameras (BWC) are mobile audio and video capture devices that can be secured to clothing allowing the wearer to record some of what they see and hear. This technology is being introduced in a range of healthcare settings as part of larger violence reduction strategies aimed at reducing incidents of aggression and violence on inpatient wards, however limited evidence exists to understand if this technology achieves such goals.

This study aimed to evaluate the implementation of BWCs on two inpatient mental health wards, including the impact on incidents, the acceptability to staff and patients, the sustainability of the resource use and ability to manage the use of BWCs on these wards.

The study used a mixed-methods design comparing quantitative measures including ward activity and routinely collected incident data at three time-points before during and after the pilot implementation of BWCs on one acute ward and one psychiatric intensive care unit, alongside pre and post pilot qualitative interviews with patients and staff, analysed using a framework based on the Consolidated Framework for Implementation Research.

Results showed no clear relationship between the use of BWCs and rates or severity of incidents on either ward, with limited impact of using BWCs on levels of incidents. Qualitative findings noted mixed perceptions about the use of BWCs and highlighted the complexity of implementing such technology as a violence reduction method within a busy healthcare setting Furthermore, the qualitative data collected during this pilot period highlighted the potential systemic and contextual factors such as low staffing that may impact on the incident data presented.

This study sheds light on the complexities of using such BWCs as a tool for ‘maximising safety’ on mental health settings. The findings suggest that BWCs have a limited impact on levels of incidents on wards, something that is likely to be largely influenced by the process of implementation as well as a range of contextual factors. As a result, it is likely that while BWCs may see successes in one hospital site this is not guaranteed for another site as such factors will have a considerable impact on efficacy, acceptability, and feasibility.

Peer Review reports

Body worn cameras (BWC) are mobile audio and video capture devices that can be secured to clothing allowing the wearer to record some of what they see and hear. In England, these have been introduced in the National Health Service (NHS) as part of a violence reduction strategy [ 1 ] which emphasises the reduction of aggression and violence against staff. The NHS Staff Survey 2022 found that 14.7% of NHS staff had experienced at least one incident of physical violence from patients, relatives or other members of the public in the previous 12 months. Violent attacks on staff were found to contribute to almost half of staff illness [ 2 ]. Levels of violence against staff working in mental health trusts remain much higher than other types of healthcare providers [ 3 ]. Numerous reports internationally highlight the increased risks faced by staff working in psychiatric care [ 4 ], though studies have reported that both ward staff and mental health patients experience violence and feeling unsafe on inpatient wards [ 5 , 6 ].

Body worn cameras have been in use for over a decade within law enforcement, where they hoped to provide transparency and accountability within use-of-force incidents and in the event of citizen complaints against police [ 7 ]. It was believed that video surveillance would help identify integral problems within the organisation, improve documentation of evidence, reduce use-of-force incidents, improve police-community relations, and provide training opportunities for officers [ 8 ]. However, a recent extensive international systematic review by Lum et al. [ 9 ], found that despite the successes noted in early evaluations, the way BWCs are currently used by police may not substantially affect most officer or citizen behaviours. Irrespective of these findings, other public services such as train operators have been implementing BWCs for security purposes, with reductions reported in the number of assaults on railway staff [ 10 ].

A recent systematic review of BWC use in public sector services established that there is a poor evidence base supporting the use of BWCs in the reduction of violence and aggression [ 11 ]. Yet, we are seeing a swift increase in the use of BWCs in mental health settings with that aim, with few studies conducted on the use of BWC technology in inpatient mental health wards, and even fewer studies exploring staff or patients’ views. Two evaluations conducted in England reported mixed results with both increases and decreases in violence and aggression found, and variation between types of wards. There is some suggestion of a reduction in more serious incidents and the use of restraint, but quality of evidence is low [ 12 , 13 ].

The use of BWCs in mental healthcare settings for safety and security remains a contentious topic due to the lack of evidence regarding the influence that such technology has on preventing violence and aggression and the complex philosophical and ethical issues raised, particularly where many patients may lack capacity and/or are detained under mental health legislation [ 14 ]. Additionally, there are concerns that BWCs may be used as a ‘quick fix’ for staff shortages rather than addressing the wider systemic and resourcing issues facing services [ 15 ]. With little independent evaluation of body-worn cameras in mental health settings, many of these concerns remain unanswered. There is also limited understanding of this technology from an implementation perspective. Therefore, in this study we aimed to conduct an independent evaluation of the introduction of BWCs as a violence reduction intervention on two inpatient mental health wards during a six-month pilot period to explore the impact of using the technology, alongside an exploration of the facilitators and barriers to implementation.

Research aim(s)

To evaluate the implementation of BWCs on two inpatient mental health wards, including the impact on incidents, the acceptability to staff and patients, the sustainability of the resource use and ability to manage the use of BWCs on these wards.

Patient and public involvement

The research team included a researcher and independent consultant, each with lived experience of mental health inpatient care. In addition, we recruited and facilitated a six member Lived Experience Advisory Panel (LEAP). This group was made up of patients and carers, some of whom had experienced the use of BWCs. Members were of diverse ethnic backgrounds and included four women and two men. The LEAP provided guidance and support for the research team in developing an understanding of the various potential impacts of the use of BWCs on inpatient mental health wards. Members contributed to the design of the study, development of the interview schedule, practice interviews prior to data collection on the wards, and supported the analysis and interpretation of the data, taking part in coding sessions to identify themes in the interview transcripts. The LEAP met once a month for two hours and was chaired by the Lived Experience Research Assistant and Lived Experience Consultant. Participants in the LEAP were provided with training and paid for their time.

The pilot introduction of the body worn cameras was conducted within a London mental health Trust consisting of four hospital sites with 17 acute wards. The research team were made aware of extensive preparatory work and planning that was conducted at a directorate and senior management level prior to camera implementation, including lived experience involvement and consultation, and the development of relevant policies and protocols inclusive of a human rights assessment and legal consultation.

The pilot period ran from 25th April to 25th October 2022. Reveal (a company who supply BWCs nationally across the UK) provided the Trust with 12 Calla BWCs for a flat fee that covered use of the cameras, cloud-based storage of footage, management software, and any support/maintenance required during the pilot period. Cameras were introduced to two wards based on two hospital sites, with six cameras provided to each of the wards on the same date. Training on using the BWCs was provided by the BWC company to staff working on both wards prior to starting the pilot period. Ward one was a 20-bed male acute inpatient ward, representing the most common ward setting where cameras have been introduced. Ward two was a ten-bed male Psychiatric Intensive Care Unit (PICU), representing smaller and more secure wards in which patients are likely to present as more unwell and where there are higher staff to patient ratios.

To answer our research questions, we used a mixed-methods design [ 16 ]. Using this design allowed us to investigate the impact of implementing BWCs in mental health settings on a range of quantitative and qualitative outcomes. This mixed methods design allows the study to statistically evaluate the effectiveness of using BWCs in these settings on key dependent variables (i.e., rates of violence and aggression, and incidents of conflict and containment) alongside qualitatively exploring the impact that the implementation of such technology has on patients and staff.

To ensure that the study was able to capture the impact and effect of implementation of the cameras, a repeated measures design was utilised to capture data at three phases on these wards:

Pre-pilot data: data prior of the implementation of the BWCs (quantitative and qualitative data).

Pilot period data: data collected during the six-month pilot period when BWCs were implemented on the wards (quantitative and qualitative data).

Post-pilot: data collected after the pilot period ended and cameras had been removed from the wards (quantitative data only).

Quantitative methods

Quantitative data was collected at all three data collection periods:

Pre-period: Data spanning six months prior to the implementation of BWCs (Nov 21 to May 22).

Pilot period: Data spanning the six months of the Trusts pilot period of using BWCs on the wards (June 22 to Nov 22).

Post-pilot: Data spanning the six months following the pilot period, when BWCs had been removed (Dec 22 to May 23).

Quantitative measures

To analyse the impact of BWC implementation, we collected two types of incident data related to violence and aggression and use of containment measures, including BWCs. Combined, these data provide a view of a wide range of incidents and events happening across the wards prior to, during, and after the implementation and removal of the BWCs.

The patient-staff conflict checklist

The Patient-staff Conflict Checklist (PCC-SR) [ 17 ] is an end of shift report that is completed by nurses to collate the frequency of conflict and containment events. This measure has been used successfully in several studies on inpatient wards [ 18 , 19 , 20 ].The checklist consists of 21 conflict behaviour items, including physical and verbal aggression, general rule breaking (e.g., smoking, refusing to attend to personal hygiene), eight containment measures (e.g., special observation, seclusion, physical restraint, time out), and staffing levels. In tests based on use with case note material, the PCC-SR has demonstrated an interrater reliability of 0.69 [ 21 ] and has shown a significant association with rates of officially reported incidents [ 22 ].

The checklist was revised for this study to include questions related to the use of BWCs ( e.g., how many uses of BWCs happened during the shift when a warning was given and the BWC was not used; when a warning was given and the BWC was used; when the BWC was switched on with no warning given ) in order to provide insight into how the cameras were being used on each ward (see appendix 1). Ward staff were asked to complete the checklist online at the end of each shift.

Routinely collected incident data (via datix system)

To supplement the PCC-SR-R, we also used routinely collected incident data from both wards for all three data collection phases. This data is gathered as part of routine practice by ward staff members via the Datix system Datix [ 23 ] is a risk management system used widely across mental health wards and Trusts in the UK to gather information on processes and errors. Previous studies have utilised routinely collect data via this system [ 24 , 25 ]. Incidents recorded in various Datix categories were included in this study (see Table  1 ). Incidents were anonymised before being provided to the research team to ensure confidentiality.

Routinely collected data included:

Recorded incidents of violence and aggression.

Recorded use of restrictive practices including seclusion, restraint, and intra-muscular medication/rapid tranquilisations.

Patient numbers.

Staffing levels.

Numbers of staff attending BWC training.

Quantitative data analysis

Incident reports.

Incident reports retrieved from Datix were binary coded into aggregate variables to examine violence and aggression, self-harm, and other conflict as outlined in Table  1 . Multivariate analyses of variance (MANOVA) were used to identify differences in type of incident (violence against person, violence against object, verbal aggression, self-harm, conflict) for each ward. MANOVA was also used to examine differences in incident outcomes (severity, use of restrictive practice, police involvement) across pre-trial, trial, and post-trial periods for each ward. Incident severity was scored by ward staff on a four-point scale (1 = No adverse outcome, 2 = Low severity, 3 = Moderate severity, 4 = Severe). Use of restrictive practice and police involvement were binary coded for presence or absence. Analyses were conducted using SPSS [ 26 ].

Patient-staff conflict checklist shift-report – revised (PCC-SR-R; )

Data were condensed into weeks for analysis rather than shifts to account for variability in PCC-SR-R submission by shift. Linear regressions assessed the relationship between BWC use and incident outcome (severity, use of restrictive practice, police involvement).

Qualitative methods

We used semi-structured qualitative interviews to explore participants’ experiences of BWCs on the ward to understand the impact of their use as well as to identify any salient issues for patients, staff and visitors that align with the measures utilised within the quantitative aspect of this study. These interviews were conducted at two time points: pre-pilot and at the end of the six-month pilot period.

Sample selection, eligibility, and recruitment

Convenience sampling was used to recruit staff and patients on wards. Researchers approached ward managers to distribute information sheets to staff, who shared that information with patients. Staff self-selected to participate in the study by liaising directly with the research team. Patients that were identified as close to discharge and having capacity to consent were approached by a clinical member of the team who was briefed on the study inclusion criteria (see Table  2 ). The staff member spoke with the patient about the study and provided them with a copy of the information sheet to consider. If patients consented, a member of the research team approached the participant to provide more information on the study and answer questions. After initial contact with the research team, participants were given a 24-hour period to consider whether they wanted to participate before being invited for an interview.

Participants were invited to take part in an interview within a private space on the ward. Interviews were scheduled for one hour with an additional 15 min before and after to obtain informed consent and answer any questions. Participation was voluntary and participants were free to withdraw at any time. To thank patients for their time, we offered a £10 voucher following the interview. Interviews were audio-recorded and saved to an encrypted server. Interview recordings were transcribed by an external company, and the research team checked the transcripts for accuracy and pseudonymised all participants. All transcripts were allocated a unique ID number and imported to MicroSoft Excel [ 27 ] for analysis.

Qualitative data analysis

Qualitative data were analysed using a framework analysis [ 28 ] informed by implementation science frameworks. Our coding framework used the Consolidated Framework for Implementation Research (CFIR) [ 29 ], which is comprised of five major domains including: Intervention Characteristics, Implementation Processes, Outer Setting, Inner Setting, and Characteristics of the Individual. Each domain consists of several constructs that reflect the evidence base of the types of factors that are most likely to influence implementation of interventions. The CFIR is frequently used to design and conduct implementation evaluations and is commonly used for complex health care delivery interventions to understand barriers and facilitators to implementation. Based on its description, the CFIR is an effective model to address our research question, particularly given the complexity of the implementation of surveillance technology such as BWCs in this acute care setting.

The initial analytic stage was undertaken by eight members of the study team with each researcher charting data summaries onto the framework for each of the interviews they had conducted on MicroSoft Excel [ 27 ]. Sub-themes within each broad deductive theme from our initial framework were then derived inductively through further coding and collaborative discussion within the research team, inclusive of Lived Experience Researcher colleagues. Pseudonyms were assigned to each participant during the anonymisation of transcripts along with key identifiers to provide context for illustrative quotes (e.g., P = patient, S = staff, A = acute ward, I = Intensive Care, Pre = pre-BWC implementation interview, Post = Post BWC implementation interview).

All participants gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Health Research Authority: London - Camden & Kings Cross Research Ethics Committee (IRAS Project ID 322,268, REC Reference 23/LO/0337).

Quantitative results

Exploring how body worn cameras were used during the pilot period.

Analysis of the PCC-SR-R provides information about how the BWCs were used on a day-to-day basis during the pilot period. Out of 543 total shift reports completed, BWC use was reported 50 times, indicating that BWCs were used on less than 10% of shifts overall; 78% of those deployments were on the Acute ward (see Figure 1 ). Overall, the majority of deployments happened as activations without a warning being given ( n  = 30, 60% of activations), 19 times the BWC was deployed with a warning but the camera was not activated (38%), and only one was the camera activated without a warning being given (2%).

BWC use by ward per week of pilot (no data available before week 6 on Ward 1)

According to the PCC-SR-R, a total of 227 incidents of aggression occurred during the pilot period across both wards (see Table  3 ). Overall, there were small statistically significant correlations between BWC usage and certain types of conflict, aggression, and restrictive practice. Results found that BWC use was positively correlated with verbal aggression and use of physical restraint. BWC use was moderately positively correlated with verbal aggression ( r  = .37, p  < .001). This indicates that BWCs were more likely to be used in incidents involving verbal aggression, which do not tend to be documented in Datix. Similarly, BWC use was moderately positively correlated with physical restraint ( r  = .31, p  < .001) indicating that they were also more likely to be used alongside physical restraint.

Exploring the impact of BWCs utilising routinely collected ward data

Acute ward results.

Routine data collected via Datix records were used to examine differences in frequency of conflict and aggression, incident severity, and use of containment measures before, during, and after introduction of BWCs on each trial ward (see Table  4 ).

There was no effect of trial period on incident type ( F (10, 592) = 1.703, p  = .077, Wilk’s Λ = 0.945), meaning there was no discernible difference in the type of incidents that occurred (E.g., verbal aggression, physical aggression) before, during, and after the pilot phase.

Incident outcomes

There was an effect of trial period on incident outcomes ( F (6, 596) = 10.900, p  < .001, Wilk’s Λ = 0.812). Incident severity was statistically significantly higher in the trial and post-trial periods compared to the pre-trial period. Use of restrictive practice was significantly lower in the post-trial period compared to the pre-trial and trial period. Police involvement was also lower in the post-trial period compared to the pre-trial and trial periods (see Table  5 ).

Results for the psychiatric intensive care unit

There was an effect of trial period on incident type ( F (10, 490) = 4.252, p  < .001, Wilk’s Λ = 0.847). Verbal aggression was statistically significantly higher in the post-trial period compared to the pre and trial periods. Self-harm was statistically significantly higher in the trial period compared to the pre-trial and post-trial periods. There were no differences in violence against a person ( p  = .162), violence against an object or conflict behaviour (see Table  4 ).

There was a statistically significant difference in incident outcome across the trial periods ( F (6, 494) = 12.907, p  < .001, Wilk’s Λ = 0.747). There was no difference in incident severity or police involvement. However, use of restrictive practice was statistically significantly higher in the pre-trial period, reducing in the test period, and reducing further in the post-trial period (see Table  5 ).

Qualitative findings

A total of 22 participants took part in interviews: five patients and 16 staff members. During the pre-pilot interviews a total of nine staff took part (five in the acute ward, four in the PICU ward) and two patients (both from the acute ward). After the pilot period, a total of eight staff took part (four from each ward) and three patients (all from the acute ward). Table  6 includes a full description of participants.

Below we have presented the key themes aligning to the five core CFIR categories of Intervention Characteristics, Characteristics of Individuals, The Process of Implementation, the Inner Setting, and The Outer Setting (see Table  7 ).

Intervention characteristics

Design and usability of wearing a bwc on the ward.

When discussing the use of the BWCs, staff noted a range of design issues related to the cameras that they said impacted on their use and acceptance of the cameras. This included the nature of the camera pulling on clothing necklines (a particular issue for female staff working on male wards), and overheating causing discomfort and irritation to skin, challenges with infection control, as well as the issue of cameras in a mental health setting where they can be easily grabbed, thrown and broken during an incident. Staff often cited these design issues as related to the lack of proactive use of the cameras on the wards.

There were issues around the devices getting overheated or about it going on your clothing, it pulls down the top… we had one person who was leading on it, whenever he was around, of course, the camera was being used, but if he wasn’t there, people weren’t as proactive in using the camera. Petra (f), Staff, A, Post.

There were also issues with staff forgetting to wear the cameras, forgetting to switch them on during incidents, and forgetting to charge them at the end of the shift, reducing the potential use of the cameras by other staff. These were perceived as key logistical issues prior to the pilot and were reported as issues at the end of the pilot by several staff on the wards.

The practicalities of will they actually turn it on in those sorts of incidents, I don’t know. Just little stuff as well, like if they don’t put it back on the docking station, so you think you’re charging it for next shift but then it’s not charged and the battery is dead, that’s one less camera to use, so little stuff. Jamal (m), Staff, A, Pre.

In relation to usability, staff noted that the cameras were small and easy to use given their simple single switch interface. It was felt that not having to upload and manage the data themselves made cameras more user friendly and usable by staff members. Protocols put into place such as signing the cameras in and out, and allocation for use during shifts were likened to procedures in place for other security measures therefore the implementation of this for the BWCs was viewed as easy for many staff.

It’s just like the ASCOM alarms that we wear. There’s a system to sign in and sign out, and that’s it. Alice (f), Staff, A, Pre.

While staff were generally positive about the usability of the cameras, some were cautious of with concerns for those less confident with technology.

… you have to be conscious that there’s some people – it’s quite easy to use, but I can say that because I’m alright using devices and all that but there’s some that are older age or not that familiar with using devices that may struggle with using it… they’re feeling a bit anxious and a bit scared, if they’re not familiar with it then they won’t use it. Jamal (m), Staff, A, Pre.

Evidence strength and quality: do BWCs change anything?

There were conflicting reports regarding the potential benefits of using BWCs on the wards, with both staff and patients reporting mixed perceptions as to whether the cameras might reduce violence and aggression. In the pre-pilot interviews, some staff reported feeling that the BWCs may have a positive impact on reducing physical violence.

I think it’s going to reduce violence and aggression on the ward…I don’t think they’ll want to punch you…they might be verbally abusive but in terms of physical that might reduce. Sarah (f), Staff, I, Pre.

Patients however noted that the cameras might hold staff to account of their own behaviours and therefore may improve care, however they felt that this impact would wear off after the first few months after which people might forget about the cameras being there.

Now they’ve got the body cams, it’s going to be a lot of changes. They’ll think, ‘Ooh well he’s on tape’. So, it might do something to their conscience, they actually start to listen to patients… until the novelty wears off and it might go back to square one again. Ian (m), Patient, A, Pre.

One staff member suggested that incident rates had reduced following introduction of the BWCs, but they remained unsure as to whether this was due to the cameras, reflecting that violence and aggression on wards can be related to many factors.

I know our violence and aggression has reduced significantly since the start of the cameras pilot… I don’t know, because obviously wearing the camera’s one thing, but if they weren’t in use, I don’t know maybe just the presence of the camera made a difference. But yeah, it’s hard to tell. Petra (f), Staff, A, Post.

In contrast, several staff reported that they had seen limited evidence for such changes.

I used it yesterday. He was aggressive and I used it, but he even when I was using [it] he doesn’t care about the camera… it didn’t make any difference… It doesn’t stop them to do anything, this camera does not stop them to do anything. Abraham (m), Staff, I, Post.

Some staff suggested that in some circumstances the cameras increased patient agitation and created incidents, so there was a need to consider whether the BWCs were going to instigate aggression in some circumstances.

There has been with a few patients because they will threaten you. They will tell you, ‘if you turn it on, I’m gonna smash your head in’. So incidents like that, I will not turn it on… Yeah, or some of them will just tell you, ‘if you come close by, I’m going to pull that off your chest’. So things like that, I just stay back. Ada (f), Staff, A, Post.

One rationale for a potential lack of effectiveness was noted by both staff and patients and was related to the levels of acute illness being experienced by patients which meant that for many they were too unwell to have insight into their own actions or those of staff switching on the cameras.

We’ve had instances where patients are so unwell that they just don’t care. You switch on the camera, whether you switch it on or not, it doesn’t really change the behaviour. ‘All right, okay, whatever switch it on’. They’re so unwell, they’re not really understanding. Petra (f), Staff, A, Post. It might make [staff] feel safer as a placebo effect, but I don’t think it would necessarily make them safer… I think the people that are likely to attack a member of staff are crazy enough that they’re not gonna even consider the camera as a factor. Harry (m), Patient, A, Pre.

This lack of evidence that the cameras were necessarily effective in reducing incident rates or severity of incidents may have had an impact on staff buy-in and the use of the cameras as a result. One staff member reflected that having feedback from senior management about the impact and evidence would have been useful during the pilot period to inform ward staff whether the cameras were influencing things or not.

Staff want feedback. I don’t think we’ve had any since we’ve had the cameras… it would be nice to get feedback from, I don’t know, whoever is watching it, and stuff like that. Ada (f), Staff, A, Post.

Relative advantage: are BWCs effective and efficient for the ward?

Due to a combination of personal beliefs related to BWCs, the lack of evidence of their impact on violence and aggression, and other elements of care and culture on the wards, a number of staff and patients explored alternative interventions and approaches that may be more beneficial than BWCs. Both staff and patients suggested that Closed Circuit Television (CCTV) as an intervention that provided the transparency of using cameras and video footage but with an independent perspective. This was felt by many to remove the bias that could be introduced in BWC use as the video capture didn’t require staff control of the filming.

I feel like [BWCs] puts all the power and trust into the hands of the staff and I feel that it would be better to have CCTV on the ward because CCTV is neutral. Harry (m), Patient, A, Pre. I have control over that [BWC recording] … It kind of gives that split as well between staff and patients. You can tell me or I can tell you when to switch it on. Whereas I feel like a CCTV camera is there all the time. Nobody’s asking to switch it on. It’s there. If you wanted to review the footage you can request it, anyone can request to view the footage for a legitimate reason. Whereas the camera can come across as if you’re threatening. Petra (f), Staff, A, Post.

In addition, some participants reflected that the nature and design of BWCs meant that unless staff were present for an incident it wouldn’t be captured, whereas CCTV has the advantage of being always present.

If there’s CCTV, then it’s the same thing, you get me. Like, if its body worn cameras that people can always do things away from staff. They can always go down to that corridor to have their fight or go to the side where staff ain’t gonna see them to have their fight, but with CCTV you can’t do that. Elijah (m), Patient, A, Post.

In addition to exploring technological and video-based interventions, many staff noted that the key tool to violence reduction had to be the use of de-escalation skills, noting that the use of communication and positive relationships had to be the primary tool before other interventions such as BWCs or CCTV.

We do a lot of verbal de-escalation. So we got our destress room now still open. That has a punch bag, and it’s got sensory tiles, and the aim and hope is that when people do get frustrated, because we’re all human. We all get annoyed at anything or many little things in life. There is the aim that they go into that room and start punching the bag instead of property and damaging furniture. But we also are working really hard on verbal de-escalation and actually trying to listen to patients and talk to them before anything else. And that’s helped a lot. And between this kind of shared, or role modelling, where while we’re showing staff, actually even spending an extra 20 min is okay. If it means you’re not going to end up having to restrain a patient. Petra (f), Staff, A, Post.

By using communication skills and de-escalation techniques skilfully, some staff felt there was no need to utilise the BWCs. One concern with the introduction of the BWCs for staff was that the use of this technology may negatively impact on trust and relationships and the use of de-escalation.

Some situations I feel like it can make a situation worse sometimes… I think a lot of situations can be avoided if you just talk with people…. Trying to find out why they’re angry, trying to just kind of see it from their point of view, understand them… I think maybe additional training for verbal de-escalation is needed first. Patrick (m), Staff, A, Post.

Characteristics of individuals

Staff and patients’ knowledge and beliefs about the intervention.

Overall, there were mixed views among both staff and patients as to whether cameras would reduce incidents, prior to and after the pilot period. When considering the possible impact on violence and aggressive incidents there was a view among staff that there was the need for a nuanced and person-centred view.

All the patients that come in, they’re different you know. They have different perceptions; they like different things… everyone is different. So, it just depends. We might go live, and then we have good feedback because the patients they are open and the understand why we have it, and then as they get discharged and new patients come in it might not go as well. It just depends. Serene (f), Staff, A, Pre.

As a result of the desire to be person-centred in the use of such interventions, one staff member noted that they weighed-up such consequences for the patient before using the BWC and would make decisions not to use the camera where they thought it may have a negative impact.

Actually, with this body worn camera, as I did mention, if a patient is unwell, that doesn’t, the patient will not have the capacity to I mean, say yes, you cannot just put it on like that. Yeah, I know it’s for evidence, but when something happens, you first have to attend to the patient. You first have to attend to the patient before this camera is, for me. Ruby (f), Staff, I, Post.

Some staff questioned the existing evidence and theories as to why BWCs work to reduce incidents, and instead noted that for some people it will instigate an incident, while others may be triggered by a camera.

I’m on the fence of how that is going to work because I know the evidence is that by telling a patient ‘look if you keep escalating I’m gonna have to turn this on’, but I know several of our patients would kind of take that as a dare and escalate just to spite so that you would turn it on. Diana (f), Staff, A, Pre.

In contrast, some staff felt the cameras helped them feel safer on wards due to transparency of footage as evidence for both staff and patients.

They [staff] need to use it for protection, for recording evidence, that type of thing… They can record instances for later evidence. Yeah, for them as well. Safer for them and for patients because you can also have the right to get them to record, because a patient might be in the wrong but sometimes it may be the staff is in the wrong position. And that’s achieving safety for patients as well. Yeah, I think it works both ways. Dylan (m), Patient, A, Post.

Positive buy-in was also related to the potential use of the intervention as a training, learning or reflective tool for staff to improve practice and care and promote positive staff behaviour.

If you know that your actions might be filmed one way or the other, that would make me to step up your behaviour to patients… if you know that your actions can be viewed, if the authority wants to, then you behave properly with patients so I think that will improve the quality of the care to patient. Davide (m), Staff, I, Pre.

While there were some positive attitudes towards the cameras, there remained considerable concerns among participants regarding the transparency of camera use to collate evidence in relation to incidents as it was widely noted that the cameras remain in staff control therefore there is an issue in relation to bias and power.

I do think my gut would say that it wouldn’t necessarily be well received. Because also I think people feel like prisoners in here, that’s how some of the patients have described their experience, so in terms of the power dynamic and also just – I think that can make one feel a bit, even worse, basically, you know? Leslie (m), Staff, A, Pre.

These issues lead to staff reporting they didn’t want to wear the camera.

I’d feel quite uncomfortable wearing one to be honest. Leslie (m), Staff, A, Pre.

The staff control of the cameras had a particular impact on patient acceptability of the intervention as it led to some patients viewing BWCs as being an intervention for staff advantage and staff safety, thus increasing a ‘them and us’ culture and leading to patient resistance to the cameras. This was particularly salient for those with prior negative experiences of police use of cameras or mistrust in staff.

I feel like the fact that the body worn cameras is gonna be similar to how the police use them, if a staff member has negative intent toward a patient, they would be able to instigate an incident and then turn the camera on and use the consequences of what they’ve instigated to expect restraint or injection or whatever else might happen. So, I feel like it would be putting all the power and trust into the hands of the staff and I feel that it would be better to have CCTV on the ward because CCTV is neutral. Whereas, the body worn camera, especially with some of the personality conflicts/bad attitudes, impressions I’ve had from certain members of staff since I’ve been here, I feel like body worn cameras might be abused in that way possible. Harry (m), Patient, A, Pre.

Perceived unintended consequences and impact on care

Prior to the implementation there were concerns from staff that the introduction of BWCs could have consequences beyond the intended use of reducing violence and aggression, unintentionally affecting a range of factors that may impact on the overall delivery of care. There was a key concern regarding the potential negative impact that cameras may have for patients who have paranoia or psychosis as well as for those who may have prior traumatic experiences of being filmed.

It might have negative impacts on these patients because I’m thinking about kind of patients with schizophrenia and things like that who already have paranoid delusions, thinking that people are after them, thinking that people are spying on them, people are watching them, and then seeing kind of cameras around. It might have negative impacts on them. Tayla (f), Staff, I, Pre. When I was admitted I was going through psychosis… I don’t want to be filmed and things like that. So you just see a camera, a guy with a camera on, you are like, are you filming me? Elijah (m), Patient, A, Post.

There was also a considerable concern among both staff and patients that the use of cameras would have a negative impact on the therapeutic relationship between staff and patients. This was felt to be related to the implication that the cameras enhanced a ‘them and us’ dynamic due to the power differential that staff controlling the cameras can create, likened to policing and criminalisation of patients. With the potential of a negative impact on relationships between staff and patients, staff suggested they may be disinclined to use BWCs if it would stop patients speaking to them or approaching them if they needed support.

Yeah, I think it would probably damage [the therapeutic relationship] because I think what’s probably quite helpful is things that maybe create less of a power difference. I think to some extent, [the BWC] might hinder that ability. Like for example imagine going to a therapist and them just like ‘I’ve got this camera in the corner of the room and it’s gonna be filming our session and just in case – or like, just in case I feel that you might get aggressive with me’. Um, I don’t think that’s going to help the therapeutic relationship! Jamal (m), Staff, A, Pre. When you get body worn cameras on there, the relationship as well between staff and patients, is just gonna instantly change because you’re looking like police! Elijah (m), Patient, A, Post.

In contrast, a minority of staff felt that the presence of cameras may improve relationships as they provide transparency of staff behaviour and would encourage staff to behave well and provide high quality care for patients.

It will also help how, improve the way we look at the patients… because if you know that your actions might be filmed one way or the other, that would make me to step up your behaviour you know… you behave properly with patients so I think that will improve the quality of the care to patient. More efficiently, more caring to patient. Davide (m), Staff, I, Pre.

The process of implementation

Planning: top-down implementation.

Staff perceived that BWC implementation directives had been given by senior management or policy stakeholders whom they felt viewed the process from a position of limited understanding due to a lack of ‘frontline’ mental health service experience. This led to a lack of faith amongst staff, and a perception that funds were being misspent.

They sit up there, they just roll it out and see how it works, how it goes. They waste a whole lot of money, millions or whatever, thousands of pounds in it, and then they see that ‘Oh, it’s not gonna work’. They take it back and all of that. Before coming out with it, you need to come speak to us… they just sit up there drinking tea and coffee, and then they’re just like, Oh, yeah, well, let’s do it this way…come stay with these people, work with them, for just I give you a 12 h shift, stay with them. Richard (m), Staff, I, Post.

This was exacerbated when staff felt there was a lack of consultation or explanation.

we don’t always get the ins and outs of certain things…We know that the cameras are coming in and stuff like that, but you know, and obviously it’s gone through every avenue to make sure that it’s fine. But then sometimes we don’t always know the ins and outs to then explain to people why we have the cameras. Patrick (m), Staff, A, Post.

It was also highlighted that due to multiple initiatives being implemented and directives handed down in parallel, staff felt negative towards interventions more widely, with the BWCs being ‘ just another thing to do’ , adding to workload for staff and reducing enthusiasm to use the cameras.

it’s not just to do with the camera, I just think there’s lots of changes happening at once, and there’s loads of new things being constantly introduced that people are just thinking oh it’s another thing. I think that’s what it is more than the camera itself. Alice (f), Staff, A, Pre.

Execution: training, Use and Ward Visibility

Overall, there was a lack of consistency amongst staff in their understanding of the purpose and processes of using the BWCs on the wards.

What do you do, do you record every single thing or, I don’t know. Do you record like, if a patient said, I want to talk to you, confidential, you go sit in a room, do you record things like those or is it just violence and aggression? Ada (f), Staff, A, Post.

The lack of clarity regarding the purpose of the intervention and the appropriate use of the cameras was felt to impact staffs’ attitudes and acceptance of using them and contributed to a lack of transparency or perhaps trust regarding the use of any subsequent video footage.

I think if the importance of the recording was explained a bit more…and how it would improve things, I think people would use it more… that’s why I don’t think it’s always used sometimes… if you’re not sure why some of it’s important, then you’re not going to see the value…I think if you’re gonna keep with them, it’s about updating the training, teaching staff when to use it, then where does that information go? How does that look in terms of improving? Just a bit of transparency, I think. But when you don’t know certain things it’s a bit hard to get behind something or back it, you know? Patrick (m), Staff, A, Post.

The lack of information about the purpose and processes related to the intervention was also seen among patients, with most patients noting that they hadn’t received information about the cameras during their admissions.

No information at all. I don’t think any of the patients know about it. Toby (m), Patient, A, Post.

While training was provided it was widely felt that it was insufficient to provide understanding about the purpose of the cameras or the more in-depth processes beyond operational aspects such as charging and docking. Several staff interviewed were unaware of the training, while others noted that they had an informal run-through by colleagues rather than anything formal.

What training are you talking about?… I wasn’t here, so I was taught by my colleague. I mean, from what I was taught, to operate the camera, and to give a warning to the patient that you’re going to use the camera. Nevis (f), Staff, A, Post.

Longer training with further details beyond operational use was felt to be needed by staff.

I think the training should have to be longer, even if it’s like an hour or something… Like what situations deem the camera to be… more information on the cameras, when to use it, why it’s used, and I think if the importance of the recording was explained a bit more and what it was doing and how that recording would go and how it would improve things. Patrick (m), Staff, A, Post.

Furthermore, there was a need for training to be on a rolling basis given the use of bank staff who were not trained to use the cameras or to understand the proper processes or purpose of using the BWCs, which could leave them vulnerable to misuse or abuse.

We have bank staff [who aren’t trained] so they say ‘I don’t know how to use that camera you are giving me’. Nevis (f), Staff, A, Post.

The inner setting

Ward context: acceptance of violence and aggression is part of the job.

It was widely believed by staff that the nature of working on a mental health ward included accepting that violence and aggression was part of the job. This was not seen as an acceptance of violence but more that the job was providing care for individuals who are mentally unwell, and confusion, fear, frustration and aggression can be part of that. As a result, there was an ambivalence among some staff that the introduction of cameras would change this.

I think like in this line of work, there’s always that potential for like risky behaviours to happen. I’m not sure if putting the camera on will make much difference. Patrick (m), Staff, A, Post.

Staff noted that because of the nature of the job, staff are used to managing these situations and they understood that it was part of the job; therefore, it was unlikely that they would record everything that on paper might be considered an incident.

There’s also enough things that happen here, so I don’t think they would record [the incidents] because it’s just another day here. You know what I’m saying… [staff] can just say, ‘Stop, go back to your room and leave it at that and that kind of be the end of it’. Dylan (m), Patient, A, Post. We are trained for it. Eveline (f), Staff, I, Pre.

This acceptance that incidents are a hazard of mental healthcare was linked to staff’s acknowledgment that many factors make up the complexity of violence and aggression including the nature of individual patients, acuity levels, ward atmosphere, staffing levels, access to activities, leave and outside space. The interplay of multiple factors creates a context in which frustrations and incidents are likely, thus become part of the everyday and ‘normal’ life on the ward for staff and patients alike.

I feel like, you know, how in GP services you say, zero tolerance to abusive language, or any kind of harassment. I don’t think there is that on a psychiatric ward you are kind of expected to take all the abuse and just get on with it. Petra (f), Staff, A, Post.

With staff reported having a higher threshold for these behaviours it was perceived that this was likely to impact on the efficiency of the intervention as staff would be less likely to consider a situation as violent but more ‘ part of the job’ .

Reactive nature of the ward and incidents

Most participants noted that the ward context is always changing with people being admitted and discharged, with daily staff changes and wider turnover of staff, so things are never static and can change at any point. This reflects the dynamic nature of the ward which creates a complex moving picture that staff need to consider and react to.

[the atmosphere] it’s very good at the moment. If you had asked me this two weeks ago, I would say, ‘Oh, my gosh’. But it changes… The type of patient can make your whole ward change… it depends on the client group we have at the time. Nevis (f), Staff, A, Post.

Staff noted that a key limitation of using the cameras to reduce incidents was the reactive nature of the environment and care being provided. This was felt to impact on the feasibility and use of the cameras as staff noted that they often react to what is happening rather than thinking to ‘ put the camera on first ’. It was felt by staff with experience of reacting to incidents that the failure to use BWCs during these processes were linked to staff’s instincts and training to focus on patients as a priority.

Say for instance, you’re in the office, and two patients start fighting, or a patient attacks someone and, all you’re thinking about is to go there to stop the person. You’re not thinking about putting on any camera. You understand? So sometimes it’s halfway through it, somebody might say, ‘Has anybody switched the camera on’? And that’s the time you start recording… If something happens immediately, you’re not thinking about the camera at that time, you’re just thinking to just go, so yeah. Nevis (f), Staff, A, Post.

Incidents happen quickly and often surprise staff, therefore staff react instantly so are not thinking about new processes such as recording on the cameras as this would slow things down or is not in the reactive nature needed by staff during such incidents.

When you’re in the middle of an incident and your adrenaline’s high, you’re focusing on the incident itself. It’s very difficult for you to now remember, remind yourself to switch on the camera because you’re thinking, patient safety, staff safety, who’s coming to relieve you? What’s going on? Who’s at the door? Petra (f), Staff, A, Post.

In addition, the need for an immediate response meant that it was felt that by the time staff remember to, or have the chance to, switch the camera on it was often too late.

Sometimes in the heat of moments and stuff like that, or if the situation’s happening, sometimes you don’t always think to, you know, put your camera on. Patrick (m), Staff, A, Post.

Outer setting

Resources: staffing.

Issues related to staffing were highlighted by several participants as a key problem facing mental health wards thus leading to staff having higher workloads, and higher rates of bank and agency staff being used on shift and feeling burnt-out.

Out of all the wards I’ve been on I’d say this is the worst. It’s primarily because the staff are overworked…it seems like they spend more time doing paperwork than they do interacting with the patients. Harry (m), Patient, A, Pre. We’re in a bit of a crisis at the minute, we’re really, really understaffed. We’re struggling to cover shifts, so the staff are generally quite burnt out. We’ve had a number of people that have just left all at once, so that had an impact… Staff do get frustrated if they’re burnt out from lack of staff and what have you. Alice (f), Staff, A, Pre.

It was noted by one participant that the link of a new intervention with extra workload was likely to have a negative impact on its acceptability due to these increasing demands.

People automatically link the camera to then the additional paperwork that goes alongside it. It’s like, ‘Oh god, if we do this, we’ve got to do that’, and that could play a part. Petra (f), Staff, A, Post.

One staff member noted that the staffing issue meant there were more likely to be bank staff on wards so the care of patients may be affected as temporary staff may be less able to build meaningful therapeutic relationships.

So obviously there is the basic impact on safety of not having adequate staffing, but then there’s the impact of having a lot of bank staff. So obviously when you have permanent staff they get to know the patients more, we’re able to give them the more individualised care that we ideally should be giving them, but we can’t do that with bank staff. Diana (f), Staff, A, Pre.

It was also suggested that staffing levels and mix often made it more difficult to provide activities or facilitate escorted leave which can lead to patients feeling frustrated and becoming more aggressive.

So you know there is enough staff to facilitate the actual shift, so you know when there’s less staff like you say you’ve got people knocking at the door, but then you don’t have staff to take people out on leave straight away, that all has a rippling effect! Serene (f), Staff, A, Pre.

Wider systemic issues

Overall, there was a concern that the introduction of BWCs would not impact on wider, underlying factors that may contribute to frustration, aggression and incidents on wards. Providing a more enhanced level of care and better addressing the needs of patients was felt to be central to helping people but also reducing the frustration that patients feel when on the ward.

… for violence and aggression, [focus on] the mental health side of things like therapy and psychology should be compulsory. It shouldn’t be something you apply for and have to wait three or four weeks for. I think every person should, more than three or four weeks even, months even… we need psychology and therapists. That’s what will stop most violence, because psychologists and a therapist can edit the way that they speak to people because they’ve been given that skill depending on the way the person behaves. So that’s what we need regularly… not like all this dancing therapy, yoga therapy. That’s a person, that you come and you actually sit down and talk through your shit with them. That will help! Elijah (m), Patient, A, Post. There’s a lack of routine and I think there’s a lack of positive interaction between the patient and the staff as well. The only time you interact with a member of staff is if you’re hassling them for something, you have to hassle for every little thing, and it becomes a sort of, frustration inducing and like I’m a very calm person, but I found myself getting very fucking angry, to be honest, on this ward just because out of pure frustration… there’s bigger problems than body worn cameras going on. Harry (m), Patient, A, Pre.

Staff agreed that there was a need to invest in staff and training rather than new technologies or innovations as it is staff and their skills behind the camera.

It’s not the camera that will do all of that. It’s not making the difference. It’s a very good, very beautiful device, probably doing its job in its own way. But it’s more about investing in the staff, giving them that training and making them reflect on every day-to-day shift. Richard (m), Staff, I, Post.

There was felt to be a need to support staff more in delivering care within wards that can be challenging and where patients are unwell to ensure that staff feel safe. While in some circumstances the cameras made some staff feel safer, greater support from management would be more beneficial in making staff feel valued.

In this study exploring the implementation and use of body-worn cameras on mental health wards, we employed two methods for collecting and comparing data on incidents and use of containment measures, including BWCs, on one acute ward and one psychiatric intensive care unit. We found no clear relationship between the use of BWCs and rates or severity of incidents on either ward. While BWCs may be used when there are incidents of both physical and verbal aggression, results indicate that they may also provoke verbal aggression, as was suggested during some interviews within this study. This should be a concern, as strong evidence that being repeatedly subject to verbal aggression and abuse can lead to burnout and withdrawal of care by staff [ 30 ]. These mixed findings reflect results that were reported in two earlier studies of BWCs on mental health wards [ 12 , 13 ]. However, the very low use of the cameras, on just 10 per cent of the shifts where data was obtained, makes it even more difficult to draw any conclusions.

While the data shows limited impact of using BWCs on levels of incidents, we did find that during the pilot period BWC use tended to occur alongside physical restraint, but the direction of relationship is unclear as staff were asked to use BWCs when planning an intervention such as restraint. This relationship with restraint reflected the findings on several wards in a previous study [ 13 ], while contrasting with those reported in a second study that found reductions in incidents involving restraint during the evaluation period [ 12 ]. Such a mix of findings highlights the complexity of using BWCs as a violence reduction method within a busy healthcare setting in which several interacting components and contextual factors, and behaviours by staff and patients can affect outcomes [ 31 ]. The qualitative data collected during this pilot period highlighted the potential systemic and contextual factors such as low staffing that may have a confounding impact on the incident data presented in this simple form.

The findings presented within this evaluation provide some insights into the process of implementing BWCs as a safety intervention in mental health services and highlight some of the challenges and barriers faced. The use of implementation science to evaluate the piloting of BWCs on wards helps to demonstrate how multiple elements including a variety of contextual and systemic factors can have a considerable impact and thus change how a technology may vary not only between hospitals, but even across wards in the same hospital. By understanding the elements that may and do occur during the process of implementing such interventions, we can better understand if and how BWCs might be used in the future.

Within this pilot, extensive preparatory work conducted at a directorate and senior management level did not translate during the process of implementation at a ward level, which appeared to impact on the use of BWCs by individuals on the wards. This highlights that there is a need to utilise implementation science approaches in planning the implementation of new technologies or interventions and to investigate elements related to behavioural change and context rather than just the desired and actual effects of the intervention itself.

While ward staff and patients identified the potential for BWCs to enhance safety on the wards, participants distrusted their deployment and expressed concerns about ethical issues and possible harmful consequences of their use on therapeutic relationships, care provided and patient wellbeing. These themes reflect previous findings from a national interview study of patient and staff perspectives and experiences of BWCs in inpatient mental health wards [ 14 ]. Given these issues, alternatives such as increasing de-escalation skills were identified by staff as possible routes that may be more beneficial in these settings. Furthermore, other approaches such as safety huddles have also been highlighted within the literature as potential means to improve patient safety by looking ahead at what can be attended to or averted [ 32 ].

Furthermore, it is important to consider that the presence of power imbalances and the pre-existing culture on the ward have considerable implications for safety approaches and must be considered, as exemplified by the preferences by both staff and patients in this evaluation for more perceived ‘impartial’ interventions such as CCTV. As identified within previous studies [ 14 ], BWCs can have different implications for psychological safety, particularly for vulnerable patients who already feel criminalised in an environment with asymmetrical power imbalances between staff and patients. This is particularly salient when considering aspects of identity such as race, ethnicity, and gender both in terms of the identities of the patient group but also in terms of the staff/patient relationship.

While preferences in this study note CCTV as more ‘impartial’, work by Desai [ 33 ] draws on the literature about the use of surveillance cameras in other settings (such as public streets) as well as on psychiatric wards and concludes that CCTV monitoring is fraught with difficulties and challenges, and that ‘watching’ patients and staff through the lens of a camera can distort the reality of what is happening within a ward environment. In her recently published book, Desai [ 34 ] develops this theme to explore the impacts of being watched on both patients and staff through her ethnographic research in psychiatric intensive care units. She highlights concerns over the criminalisation of patient behaviour, safeguarding concerns in relation to the way women’s bodies and behaviours are viewed and judged, and the undermining by CCTV of ethical mental health practice by staff who attempt to engage in thoughtful, constructive, therapeutic interactions with patients in face-to-face encounters. Appenzeller et al.’s [ 35 ] review found that whilst the presence of CCTV appeared to increase subjective feelings of safety amongst patients and visitors, there was no objective evidence that video surveillance increases security, and that staff may develop an over-reliance on the technology.

In addition, our findings add to the existing literature which notes that alternative interventions and approaches that address underlying contextual and systemic issues related to improving care on inpatient wards require attention to address the underlying factors related to incidents, e.g., flashpoints [ 36 ]. Evidence suggests that factors leading to incidents can be predicted; therefore, there is a need to enable staff to work in a proactive way to anticipate and prevent incidents rather than view incidents as purely reactive [ 37 , 38 , 39 ]. Such skills-based and relational approaches are likely to impact more on improving safety and reducing incidents by addressing the complex and multi-faceted issue of incidents on inpatient mental health wards [ 40 ].

These findings highlight that interventions such as BWCs are not used within a vacuum, and that hospitals are complex contexts in which there are a range of unique populations, processes, and microsystems that are multi-faceted [ 41 ]. As a result, interventions will encounter both universal, specific, and local barriers that will impact on its functioning in the real world. This is salient because research suggests that camera use inside mental health wards is based on a perception of the violent nature of the mental health patient, a perception that not only influences practice but also impacts how patients experience the ward [ 33 ]. As a result, there needs to be careful consideration of the use of any new and innovative intervention aimed at improving safety within mental health settings that have limited research supporting their efficacy.

Limitations

While the study provides important insights into the efficacy and acceptability of introducing BWCs onto inpatient mental health wards, there were several limitations. Firstly, the analysis of incident data is limited in its nature as it only presents surface level information about incidents without wider contextual information. Results using such data should be cautiously interpreted as they do not account for confounding factors, such as staffing, acuity, ward culture or ward atmosphere, that are likely to contribute to incidents of violence and aggression. For example, while there was a statistically significant decrease in restrictive practice on the PICU across the study period, we know that BWCs were not widely used on that ward, so this is likely due to a confounding variable that was not accounted for in the study design.

Secondly, the study faced limitations in relation to recruitment, particularly with patients. Researchers’ access to wards was challenging due to high staff turnover and high rates of acuity, meaning many patients were not deemed well enough to be able to consent to take part in the study. In addition, the low use of the cameras on wards meant that many patients, and some staff, had not seen the BWCs in use. Similarly, patients had been provided limited information about the pilot, so their ability to engage in the research and describe their own experiences with BWCs was restricted.

Thirdly, analysis captures the active use of the BWC, however it does not fully capture the impact of staff wearing the cameras even where they do not actively use them. While our qualitative analysis provides insight into the limitation of such passive use, it is likely that the presence of the cameras being worn by staff, even when turned off, may have an impact on both staff and patient behaviours. This may explain trends in the data that did not reach significance but warrant further investigation in relation to the presence of BWCs, nonetheless.

Finally, researchers had planned to collect quantitative surveys from staff and patients in relation to their experiences of the ward atmosphere and climate, views related to therapeutic relationships on the ward, levels of burnout among staff, views on care, and attitudes to containment measures. Due to issues related to staff time, patient acuity, and poor engagement from staff leading to challenges accessing the wards, the collection of such survey data was unfeasible, and this element of the study was discontinued. As a result, we have not reported this aspect in our paper. This limitation reflects the busy nature of inpatient mental health wards with pressures on staff and high levels of ill health among patients. As such, traditional methodologies for evaluation are unlikely to elicit data that is comprehensive and meaningful. Alternative approaches may need to be considered.

Future directions

With BWCs being increasingly used across inpatient mental health services [ 14 ], it is important that further research and evaluation is conducted. To date, there is limited data regarding the effectiveness of this technology in relation to violence reduction; however, there may be other beneficial uses in relation to safeguarding and training [ 13 ]. Future research should consider alternative methods that ensure contextual factors are accounted for and that patient voices can be maximised. For example, focus groups with patients currently admitted to a mental health ward or interviews with those who have recently been on a ward that has used the cameras, would bypass problems encountered with capacity to consent in the present study. Furthermore, ethnographic approaches may provide a deeper understanding of the implementation, deployment and impact that BWCs have on wards.

Overall, this research sheds light on the complexities of using BWCs as a tool for ‘maximising safety’ in mental health settings. The findings suggest that BWCs have a limited impact on levels of incidents on wards, something that is likely to be largely influenced by the process of implementation as well as a range of contextual factors, including the staff and patient populations on the wards. As a result, it is likely that while BWCs may see successes in one hospital site this is not guaranteed for another site as such factors will have a considerable impact on efficacy, acceptability, and feasibility. Furthermore, the findings point towards the need for more consideration to be placed on processes of implementation and the complex ethical discussions regarding BWC use from both a patient and a staff perspective.

In conclusion, while there have been advances in digital applications and immersive technologies showing promise of therapeutic benefits for patients and staff more widely, whether BWCs and other surveillance approaches are to be part of that picture remains to be seen and needs to be informed by high-quality, co-produced research that focuses on wider therapeutic aspects of mental healthcare.

Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Department of Health and Social Care. The NHS Long Term Plan. 2019. https://www.longtermplan.nhs.uk/about/ . [Accessed on 01/11/2021].

NHS England. Violence prevention and safety. 2023. https://www.england.nhs.uk/supporting-our-nhs-people/health-and-wellbeing-programmes/violence-prevention-and-safety/#:~:text=The%20impact%20on%20staff%20is,thinking%20about%20leaving%20the%20organisation . [Accessed on 06/07/23].

Royal College of Nursing. Violence and aggression in the NHS: estimating the size and the impact of the problem. London: Royal College of Nursing; 2018.

Google Scholar  

Iozzino L, Ferrari C, Large M, Nielssen O, de Girolamo G. Prevalence and risk factors of violence by psychiatric acute inpatients: a systematic review and meta-analysis. PLoS ONE. 2015;10(6):e0128536. https://doi.org/10.1371/journal.pone.0128536 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Cranage K, Foster K. Mental health nurses’ experience of challenging workplace situations: a qualitative descriptive study. Int J Ment Health Nurs. 2020;31(3):665–76. https://doi.org/10.1111/inm.12986 .

Article   Google Scholar  

Jenkin G, Quigg S, Paap H, Cooney E, Peterson D, Every-Palmer S. Places of safety? Fear and violence in acute mental health facilities: a large qualitative study of staff and service user perspectives. PLoS ONE. 2022;17(5):e0266935. https://doi.org/10.1371/journal.pone.0266935 .

Gaub JE, Choate DE, Todak N, Katz CM, White MD. Officer perceptions of body-worn cameras before and after deployment: a study of three departments. Police Q. 2016;19(3):275–302.

Cubitt TI, Lesic R, Myers GL, Corry R. Body-worn video: a systematic review of literature. Australian New Z J Criminol. 2017;50(3):379–96. https://doi.org/10.1177/0004865816638909 .

Lum C, Koper CS, Wilson DB, Stoltz M, Goodier M, Eggins E et al. Body-worn cameras’ effects on police officers and citizen behavior: A systemitic review. Campbell Syst Reviews. 2020;16(3), e1112.

Ariel B, Newton M, McEwan L, Ashbridge GA, Weinborn C, Brants HS. Reducing assaults against Staff using body-worn cameras (BWCs) in Railway stations. Criminal Justice Rev. 2019;44(1):76–93.

Wilson K, Eaton J, Foye U, Ellis M, Thomas E, Simpson A. What evidence supports the use of body worn Cameras in mental health inpatient wards? A systematic review and narrative synthesis of the effects of body worn Cameras in public sector services. Int J Ment Health Nurs. 2021. https://doi.org/10.1111/inm.12954 .

Article   PubMed   PubMed Central   Google Scholar  

Ellis T, Shurmer DL, Badham-May S, Ellis-Nee C. The use of body worn video cameras on mental health wards: results and implications from a pilot study. Mental Health Family Med. 2019;15:859–68.

Hardy S, Bennett L, Rosen P, Carroll S, White P, Palmer-Hill S. The feasibility of using body-worn cameras in an inpatient mental health setting. Mental Health Family Med. 2017;13:393–400.

Wilson K, Foye U, Thomas E, Chadwick M, Dodhia S, Allen J, Lynn J, Brennan G, Simpson A. Exploring the use of body-worn cameras in acute mental health wards: a qualitative interview study with mental health patients and staff. Int J Nurs Stud. 2023;140:104456. https://doi.org/10.1016/j.ijnurstu.2023.104456 .

Article   PubMed   Google Scholar  

Baker J, Pryjmachuk S. Will safe staffing in Mental Health nursing become a reality? J Psychiatry Mental Health Nurs. 2016;23(2):75–6. https://doi.org/10.1111/jpm.12282 .

Article   CAS   Google Scholar  

Piano VL, Creswell JW. Understanding Research: A Consumer Guide. 2nd edition. 2015. Boston: Pearson Education, INC.

Bowers L, Simpson A, Alexander J. Patient-staff conflict: results of a survey on acute psychiatric wards. Soc Psychiatry Psychiatr Epidemiol. 2013;38(7):402–8.

Bowers L. The City-128 study of observation and outcomes. BMC Psychiatry. 2007;7(Suppl 1). https://doi.org/10.1186/1471-244X-7-S1-S122 . S122.

Bowers L, Flood C, Brennan G, Allan T. A replication study of the City nurse intervention: reducing conflict and containment on three acute psychiatric wards. J Psychiatr Ment Health Nurs. 2008;15:737–42. https://doi.org/10.1111/j.1365-2850.2008.01294.x .

Article   CAS   PubMed   Google Scholar  

Bowers L, James K, Quirk A, Simpson A, Stewart D, Hodsoll J, SUGAR. Reducing conflict and containment rates on acute psychiatric wards: the safewards cluster randomised controlled trial. Int J Nurs Stud. 2015;52(9):1412–22. https://doi.org/10.1016/j.ijnurstu.2015.05.001 . Erratum in: Int J Nurs Stud. 2016;58:102. PMID: 26166187; PMCID: PMC4518134.

Bowers L, Douzenis A, Galeazzi G et al. Disruptive and dangerous behaviour by patients on acute psychiatric wards in three European centres. Social Psychiatry and Psychiatric Epidemiology. 2005;40, 822–828. https://link.springer.com/article/10.1007/s00127-005-0967-1 .

Bowers L, Flood C, Brennan G, LiPang M, Oladapo P. Preliminary outcomes of a trial to reduce conflict and containment on acute psychiatric wards: City nurses. J Psychiatr Ment Health Nurs. 2006;13:165–72. https://doi.org/10.1111/j.1365-2850.2006.00931.x .

Datix. (2019). Products. Retrieved from https://www.rldatix.com/en-uk/products .

Fazel S, Toynbee M, Ryland H, et al. Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model. Psychol Med. 2023;53(2):590–6. https://doi.org/10.1017/S0033291721002063 .

Mushcab H, Bunting D, Yami S, Abandi A, Hunt C. An evaluation of Datix implementation for incident reporting at Johns Hopkins Aramco Healthcare. J Patient Saf Risk Manage. 2020;25(2):67–74. https://doi.org/10.1177/2516043520905481 .

SPSS. IBM SPSS statistics for Windows. Armonk, NY: IBM Corp; 2023.

Microsoft Corporation. (2018). Microsoft Excel . Retrieved from https://office.microsoft.com/excel .

Ritchie J, Lewis J. Qualitative. Research Practice. London: Sage; 2003.

Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. https://doi.org/10.1186/1748-5908-4-50 .

Porath CL, Pearson CM. Emotional and behavioral responses to workplace incivility and the impact of hierarchical status. J Appl Soc Psychol. 2009;42(Suppl 1):E326–57. https://doi.org/10.1111/j.1559-1816.2012.01020.x .

Craig P, Dieppe P, Macintyre S, et al. Developing and evaluating complex interventions: the new medical Research Council guidance. BMJ. 2008;337. https://doi.org/10.1136/bmj.a1655 .

Taylor-Watt J, Cruickshank A, Innes J, Brome B, Shah A. Reducing physical violence and developing a safety culture across wards in East London. Br J Mental Health Nurs. 2017. https://doi.org/10.12968/bjmh.2017.6.1.35 .

Desai S. The new stars of CCTV: what is the purpose of monitoring patients in communal areas of psychiatric hospital wards, bedrooms and seclusion rooms? Divers Equality Health Care. 2009;6(1):12. [Google Scholar].

Desai S. Surveillance Practices and Mental Health: the impact of CCTV inside mental health wards. Routledge; 2022.

Appenzeller YE, Appelbaum PS, Trachsel M. Ethical and practical issues in Video Surveillance of Psychiatric Units. Psychiatric Serv. 2020;71(5):480–6. https://doi.org/10.1176/appi.ps.201900397 .

Bowers L. Safewards: a new model of conflict and containment on psychiatric wards. J Psychiatr Ment Health Nurs. 2014;21(6):499–508. https://doi.org/10.1111/jpm.12129 . PMID: 24548312; PMCID: PMC4237187.

Goodman H, Papastavrou Brooks C, Price O, Barley EA. Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: a qualitative study. Int J Mental Health Syst. 2020;14:59. https://doi.org/10.1186/s13033-020-00392-5 .

Johnson ME, Delaney KR. Keeping the unit safe: the anatomy of escalation. J Am Psychiatr Nurses Assoc. 2007;13:42–52.

Johnson ME, Hauser PM. The practice of expert nurses: accompanying the patient to a calmer space. Issues Ment Health Nurs. 2001;22:651–68.

Hamrin V, Iennaco J, Olsen D. A review of ecological factors affecting inpatient psychiatric unit violence: implications for relational and unit cultural improvements. Issues Ment Health Nurs. 2009;30(4):214 – 26. doi: 10.1080/01612840802701083. PMID: 19363726.

Squires JE, Estabrooks CA, Scott SD, Cummings GG, Hayduk L. The influence of organizational context on the use of research by nurses in Canadian pediatric hospitals. BMC Health Serv Res. 2013;13. https://doi.org/10.1186/1472-6963-13-351 .

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Acknowledgements

We would like to thank The Burdett Trust for Nursing for funding this work. We would also like to acknowledge our wider Lived Experience Advisory Panel and Project Advisory Panel for their contributions and support and would like to thank the staff and service users on the wards we attended for their warmth and participation.

Funding was provided by The Burdett Trust of Nursing. Funders were independent of the research and did not impact findings.

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All authors have read and approved the manuscript. Authors AS, UF, KW, GB created the protocol for the study. KW, JJ, UF conducted the recruitment for the study, and conducted the interviews. UF, JJ, JB, LMA, LU, SMK, KB, ET coded data, and contributed to the analysis. All authors supported drafting and development of the manuscript.

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Foye, U., Wilson, K., Jepps, J. et al. Exploring the use of body worn cameras in acute mental health wards: a mixed-method evaluation of a pilot intervention. BMC Health Serv Res 24 , 681 (2024). https://doi.org/10.1186/s12913-024-11085-x

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Qualitative study.

Steven Tenny ; Janelle M. Brannan ; Grace D. Brannan .

Affiliations

Last Update: September 18, 2022 .

• Introduction

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. [1] Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research helps generate hypothenar to further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. It could be structured as a standalone study, purely relying on qualitative data, or part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and applications of qualitative research.

Qualitative research, at its core, asks open-ended questions whose answers are not easily put into numbers, such as "how" and "why." [2] Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. [2] One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. [3] Phenomena such as experiences, attitudes, and behaviors can be complex to capture accurately and quantitatively. In contrast, a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a particular time or during an event of interest. Quantifying qualitative data certainly is possible, but at its core, qualitative data is looking for themes and patterns that can be difficult to quantify, and it is essential to ensure that the context and narrative of qualitative work are not lost by trying to quantify something that is not meant to be quantified.

However, while qualitative research is sometimes placed in opposition to quantitative research, where they are necessarily opposites and therefore "compete" against each other and the philosophical paradigms associated with each other, qualitative and quantitative work are neither necessarily opposites, nor are they incompatible. [4] While qualitative and quantitative approaches are different, they are not necessarily opposites and certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated.

Qualitative Research Approaches

Ethnography

Ethnography as a research design originates in social and cultural anthropology and involves the researcher being directly immersed in the participant’s environment. [2] Through this immersion, the ethnographer can use a variety of data collection techniques to produce a comprehensive account of the social phenomena that occurred during the research period. [2] That is to say, the researcher’s aim with ethnography is to immerse themselves into the research population and come out of it with accounts of actions, behaviors, events, etc, through the eyes of someone involved in the population. Direct involvement of the researcher with the target population is one benefit of ethnographic research because it can then be possible to find data that is otherwise very difficult to extract and record.

Grounded theory

Grounded Theory is the "generation of a theoretical model through the experience of observing a study population and developing a comparative analysis of their speech and behavior." [5] Unlike quantitative research, which is deductive and tests or verifies an existing theory, grounded theory research is inductive and, therefore, lends itself to research aimed at social interactions or experiences. [3] [2] In essence, Grounded Theory’s goal is to explain how and why an event occurs or how and why people might behave a certain way. Through observing the population, a researcher using the Grounded Theory approach can then develop a theory to explain the phenomena of interest.

Phenomenology

Phenomenology is the "study of the meaning of phenomena or the study of the particular.” [5] At first glance, it might seem that Grounded Theory and Phenomenology are pretty similar, but the differences can be seen upon careful examination. At its core, phenomenology looks to investigate experiences from the individual's perspective. [2] Phenomenology is essentially looking into the "lived experiences" of the participants and aims to examine how and why participants behaved a certain way from their perspective. Herein lies one of the main differences between Grounded Theory and Phenomenology. Grounded Theory aims to develop a theory for social phenomena through an examination of various data sources. In contrast, Phenomenology focuses on describing and explaining an event or phenomenon from the perspective of those who have experienced it.

Narrative research

One of qualitative research’s strengths lies in its ability to tell a story, often from the perspective of those directly involved in it. Reporting on qualitative research involves including details and descriptions of the setting involved and quotes from participants. This detail is called a "thick" or "rich" description and is a strength of qualitative research. Narrative research is rife with the possibilities of "thick" description as this approach weaves together a sequence of events, usually from just one or two individuals, hoping to create a cohesive story or narrative. [2] While it might seem like a waste of time to focus on such a specific, individual level, understanding one or two people’s narratives for an event or phenomenon can help to inform researchers about the influences that helped shape that narrative. The tension or conflict of differing narratives can be "opportunities for innovation." [2]

Research Paradigm

Research paradigms are the assumptions, norms, and standards underpinning different research approaches. Essentially, research paradigms are the "worldviews" that inform research. [4] It is valuable for qualitative and quantitative researchers to understand what paradigm they are working within because understanding the theoretical basis of research paradigms allows researchers to understand the strengths and weaknesses of the approach being used and adjust accordingly. Different paradigms have different ontologies and epistemologies. Ontology is defined as the "assumptions about the nature of reality,” whereas epistemology is defined as the "assumptions about the nature of knowledge" that inform researchers' work. [2] It is essential to understand the ontological and epistemological foundations of the research paradigm researchers are working within to allow for a complete understanding of the approach being used and the assumptions that underpin the approach as a whole. Further, researchers must understand their own ontological and epistemological assumptions about the world in general because their assumptions about the world will necessarily impact how they interact with research. A discussion of the research paradigm is not complete without describing positivist, postpositivist, and constructivist philosophies.

Positivist versus postpositivist

To further understand qualitative research, we must discuss positivist and postpositivist frameworks. Positivism is a philosophy that the scientific method can and should be applied to social and natural sciences. [4] Essentially, positivist thinking insists that the social sciences should use natural science methods in their research. It stems from positivist ontology, that there is an objective reality that exists that is wholly independent of our perception of the world as individuals. Quantitative research is rooted in positivist philosophy, which can be seen in the value it places on concepts such as causality, generalizability, and replicability.

Conversely, postpositivists argue that social reality can never be one hundred percent explained, but could be approximated. [4] Indeed, qualitative researchers have been insisting that there are “fundamental limits to the extent to which the methods and procedures of the natural sciences could be applied to the social world,” and therefore, postpositivist philosophy is often associated with qualitative research. [4] An example of positivist versus postpositivist values in research might be that positivist philosophies value hypothesis-testing, whereas postpositivist philosophies value the ability to formulate a substantive theory.

Constructivist

Constructivism is a subcategory of postpositivism. Most researchers invested in postpositivist research are also constructivist, meaning they think there is no objective external reality that exists but instead that reality is constructed. Constructivism is a theoretical lens that emphasizes the dynamic nature of our world. "Constructivism contends that individuals' views are directly influenced by their experiences, and it is these individual experiences and views that shape their perspective of reality.” [6]  constructivist thought focuses on how "reality" is not a fixed certainty and how experiences, interactions, and backgrounds give people a unique view of the world. Constructivism contends, unlike positivist views, that there is not necessarily an "objective"reality we all experience. This is the ‘relativist’ ontological view that reality and our world are dynamic and socially constructed. Therefore, qualitative scientific knowledge can be inductive as well as deductive.” [4]

So why is it important to understand the differences in assumptions that different philosophies and approaches to research have? Fundamentally, the assumptions underpinning the research tools a researcher selects provide an overall base for the assumptions the rest of the research will have. It can even change the role of the researchers. [2] For example, is the researcher an "objective" observer, such as in positivist quantitative work? Or is the researcher an active participant in the research, as in postpositivist qualitative work? Understanding the philosophical base of the study undertaken allows researchers to fully understand the implications of their work and their role within the research and reflect on their positionality and bias as it pertains to the research they are conducting.

Data Sampling 

The better the sample represents the intended study population, the more likely the researcher is to encompass the varying factors. The following are examples of participant sampling and selection: [7]

• Purposive sampling- selection based on the researcher’s rationale for being the most informative.
• Criterion sampling selection based on pre-identified factors.
• Convenience sampling- selection based on availability.
• Snowball sampling- the selection is by referral from other participants or people who know potential participants.
• Extreme case sampling- targeted selection of rare cases.
• Typical case sampling selection based on regular or average participants. 

Data Collection and Analysis

Qualitative research uses several techniques, including interviews, focus groups, and observation. [1] [2] [3] Interviews may be unstructured, with open-ended questions on a topic, and the interviewer adapts to the responses. Structured interviews have a predetermined number of questions that every participant is asked. It is usually one-on-one and appropriate for sensitive topics or topics needing an in-depth exploration. Focus groups are often held with 8-12 target participants and are used when group dynamics and collective views on a topic are desired. Researchers can be participant-observers to share the experiences of the subject or non-participants or detached observers.

While quantitative research design prescribes a controlled environment for data collection, qualitative data collection may be in a central location or the participants' environment, depending on the study goals and design. Qualitative research could amount to a large amount of data. Data is transcribed, which may then be coded manually or using computer-assisted qualitative data analysis software or CAQDAS such as ATLAS.ti or NVivo. [8] [9] [10]

After the coding process, qualitative research results could be in various formats. It could be a synthesis and interpretation presented with excerpts from the data. [11] Results could also be in the form of themes and theory or model development.

Dissemination

The healthcare team can use two reporting standards to standardize and facilitate the dissemination of qualitative research outcomes. The Consolidated Criteria for Reporting Qualitative Research or COREQ is a 32-item checklist for interviews and focus groups. [12] The Standards for Reporting Qualitative Research (SRQR) is a checklist covering a more comprehensive range of qualitative research. [13]

Applications

Many times, a research question will start with qualitative research. The qualitative research will help generate the research hypothesis, which can be tested with quantitative methods. After the data is collected and analyzed with quantitative methods, a set of qualitative methods can be used to dive deeper into the data to better understand what the numbers truly mean and their implications. The qualitative techniques can then help clarify the quantitative data and also help refine the hypothesis for future research. Furthermore, with qualitative research, researchers can explore poorly studied subjects with quantitative methods. These include opinions, individual actions, and social science research.

An excellent qualitative study design starts with a goal or objective. This should be clearly defined or stated. The target population needs to be specified. A method for obtaining information from the study population must be carefully detailed to ensure no omissions of part of the target population. A proper collection method should be selected that will help obtain the desired information without overly limiting the collected data because, often, the information sought is not well categorized or obtained. Finally, the design should ensure adequate methods for analyzing the data. An example may help better clarify some of the various aspects of qualitative research.

A researcher wants to decrease the number of teenagers who smoke in their community. The researcher could begin by asking current teen smokers why they started smoking through structured or unstructured interviews (qualitative research). The researcher can also get together a group of current teenage smokers and conduct a focus group to help brainstorm factors that may have prevented them from starting to smoke (qualitative research).

In this example, the researcher has used qualitative research methods (interviews and focus groups) to generate a list of ideas of why teens start to smoke and factors that may have prevented them from starting to smoke. Next, the researcher compiles this data. The research found that, hypothetically, peer pressure, health issues, cost, being considered "cool," and rebellious behavior all might increase or decrease the likelihood of teens starting to smoke.

The researcher creates a survey asking teen participants to rank how important each of the above factors is in either starting smoking (for current smokers) or not smoking (for current nonsmokers). This survey provides specific numbers (ranked importance of each factor) and is thus a quantitative research tool.

The researcher can use the survey results to focus efforts on the one or two highest-ranked factors. Let us say the researcher found that health was the primary factor that keeps teens from starting to smoke, and peer pressure was the primary factor that contributed to teens starting smoking. The researcher can go back to qualitative research methods to dive deeper into these for more information. The researcher wants to focus on keeping teens from starting to smoke, so they focus on the peer pressure aspect.

The researcher can conduct interviews and focus groups (qualitative research) about what types and forms of peer pressure are commonly encountered, where the peer pressure comes from, and where smoking starts. The researcher hypothetically finds that peer pressure often occurs after school at the local teen hangouts, mostly in the local park. The researcher also hypothetically finds that peer pressure comes from older, current smokers who provide the cigarettes.

The researcher could further explore this observation made at the local teen hangouts (qualitative research) and take notes regarding who is smoking, who is not, and what observable factors are at play for peer pressure to smoke. The researcher finds a local park where many local teenagers hang out and sees that the smokers tend to hang out in a shady, overgrown area of the park. The researcher notes that smoking teenagers buy their cigarettes from a local convenience store adjacent to the park, where the clerk does not check identification before selling cigarettes. These observations fall under qualitative research.

If the researcher returns to the park and counts how many individuals smoke in each region, this numerical data would be quantitative research. Based on the researcher's efforts thus far, they conclude that local teen smoking and teenagers who start to smoke may decrease if there are fewer overgrown areas of the park and the local convenience store does not sell cigarettes to underage individuals.

The researcher could try to have the parks department reassess the shady areas to make them less conducive to smokers or identify how to limit the sales of cigarettes to underage individuals by the convenience store. The researcher would then cycle back to qualitative methods of asking at-risk populations their perceptions of the changes and what factors are still at play, and quantitative research that includes teen smoking rates in the community and the incidence of new teen smokers, among others. [14] [15]

Qualitative research functions as a standalone research design or combined with quantitative research to enhance our understanding of the world. Qualitative research uses techniques including structured and unstructured interviews, focus groups, and participant observation not only to help generate hypotheses that can be more rigorously tested with quantitative research but also to help researchers delve deeper into the quantitative research numbers, understand what they mean, and understand what the implications are. Qualitative research allows researchers to understand what is going on, especially when things are not easily categorized. [16]

• Issues of Concern

As discussed in the sections above, quantitative and qualitative work differ in many ways, including the evaluation criteria. There are four well-established criteria for evaluating quantitative data: internal validity, external validity, reliability, and objectivity. Credibility, transferability, dependability, and confirmability are the correlating concepts in qualitative research. [4] [11] The corresponding quantitative and qualitative concepts can be seen below, with the quantitative concept on the left and the qualitative concept on the right:

• Internal validity: Credibility
• External validity: Transferability
• Reliability: Dependability
• Objectivity: Confirmability

In conducting qualitative research, ensuring these concepts are satisfied and well thought out can mitigate potential issues from arising. For example, just as a researcher will ensure that their quantitative study is internally valid, qualitative researchers should ensure that their work has credibility. 

Indicators such as triangulation and peer examination can help evaluate the credibility of qualitative work.

• Triangulation: Triangulation involves using multiple data collection methods to increase the likelihood of getting a reliable and accurate result. In our above magic example, the result would be more reliable if we interviewed the magician, backstage hand, and the person who "vanished." In qualitative research, triangulation can include telephone surveys, in-person surveys, focus groups, and interviews and surveying an adequate cross-section of the target demographic.
• Peer examination: A peer can review results to ensure the data is consistent with the findings.

A "thick" or "rich" description can be used to evaluate the transferability of qualitative research, whereas an indicator such as an audit trail might help evaluate the dependability and confirmability.

• Thick or rich description:  This is a detailed and thorough description of details, the setting, and quotes from participants in the research. [5] Thick descriptions will include a detailed explanation of how the study was conducted. Thick descriptions are detailed enough to allow readers to draw conclusions and interpret the data, which can help with transferability and replicability.
• Audit trail: An audit trail provides a documented set of steps of how the participants were selected and the data was collected. The original information records should also be kept (eg, surveys, notes, recordings).

One issue of concern that qualitative researchers should consider is observation bias. Here are a few examples:

• Hawthorne effect: The effect is the change in participant behavior when they know they are being observed. Suppose a researcher wanted to identify factors that contribute to employee theft and tell the employees they will watch them to see what factors affect employee theft. In that case, one would suspect employee behavior would change when they know they are being protected.
• Observer-expectancy effect: Some participants change their behavior or responses to satisfy the researcher's desired effect. This happens unconsciously for the participant, so it is essential to eliminate or limit the transmission of the researcher's views.
• Artificial scenario effect: Some qualitative research occurs in contrived scenarios with preset goals. In such situations, the information may not be accurate because of the artificial nature of the scenario. The preset goals may limit the qualitative information obtained.
• Clinical Significance

Qualitative or quantitative research helps healthcare providers understand patients and the impact and challenges of the care they deliver. Qualitative research provides an opportunity to generate and refine hypotheses and delve deeper into the data generated by quantitative research. Qualitative research is not an island apart from quantitative research but an integral part of research methods to understand the world around us. [17]

• Enhancing Healthcare Team Outcomes

Qualitative research is essential for all healthcare team members as all are affected by qualitative research. Qualitative research may help develop a theory or a model for health research that can be further explored by quantitative research. Much of the qualitative research data acquisition is completed by numerous team members, including social workers, scientists, nurses, etc. Within each area of the medical field, there is copious ongoing qualitative research, including physician-patient interactions, nursing-patient interactions, patient-environment interactions, healthcare team function, patient information delivery, etc. 

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Disclosure: Steven Tenny declares no relevant financial relationships with ineligible companies.

Disclosure: Janelle Brannan declares no relevant financial relationships with ineligible companies.

Disclosure: Grace Brannan declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Tenny S, Brannan JM, Brannan GD. Qualitative Study. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Published: 30 May 2024

Differential attainment in assessment of postgraduate surgical trainees: a scoping review

• Rebecca L. Jones 1 , 2 ,
• Suwimol Prusmetikul 1 , 3 &
• Sarah Whitehorn 1  

BMC Medical Education volume  24 , Article number:  597 ( 2024 ) Cite this article

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Metrics details

Introduction

Solving disparities in assessments is crucial to a successful surgical training programme. The first step in levelling these inequalities is recognising in what contexts they occur, and what protected characteristics are potentially implicated.

This scoping review was based on Arksey & O’Malley’s guiding principles. OVID and Embase were used to identify articles, which were then screened by three reviewers.

From an initial 358 articles, 53 reported on the presence of differential attainment in postgraduate surgical assessments. The majority were quantitative studies (77.4%), using retrospective designs. 11.3% were qualitative. Differential attainment affects a varied range of protected characteristics. The characteristics most likely to be investigated were gender (85%), ethnicity (37%) and socioeconomic background (7.5%). Evidence of inequalities are present in many types of assessment, including: academic achievements, assessments of progression in training, workplace-based assessments, logs of surgical experience and tests of technical skills.

Attainment gaps have been demonstrated in many types of assessment, including supposedly “objective” written assessments and at revalidation. Further research is necessary to delineate the most effective methods to eliminate bias in higher surgical training. Surgical curriculum providers should be informed by the available literature on inequalities in surgical training, as well as other neighbouring specialties such as medicine or general practice, when designing assessments and considering how to mitigate for potential causes of differential attainment.

Peer Review reports

Diversity in the surgical workforce has been a hot topic for the last 10 years, increasing in traction following the BlackLivesMatter movement in 2016 [ 1 ]. In the UK this culminated in publication of the Kennedy report in 2021 [ 2 ]. Before this the focus was principally on gender imbalance in surgery, with the 2010 Surgical Workforce report only reporting gender percentages by speciality, with no comment on racial profile, sexuality distribution, disability occurrence, or socioeconomic background [ 3 ].

Gender is not the only protected characteristic deserving of equity in surgery; many groups find themselves at a disadvantage during postgraduate surgical examinations [ 4 ] and at revalidation [ 5 ]. This phenomenon is termed ‘differential attainment’ (DA), in which disparities in educational outcomes, progression rates, or achievements between groups with protected characteristics occur [ 4 ]. This may be due to the assessors’ subconscious bias, or a deficit in training and education before assessment.

One of the four pillars of medical ethics is “justice”, emphasising that healthcare should be provided in a fair, equitable, and ethical manner, benefiting all individuals and promoting the well-being of society as a whole. This applies not only to our patients but also to our colleagues; training should be provided in a fair, equitable, and ethical manner, benefiting all. By applying the principle of justice to surgical trainees, we can create an environment that is supportive, inclusive, and conducive to professional growth and well-being.

A diverse consultant body is crucial for providing high-quality healthcare to a diverse patient population. It has been shown that patients are happier when cared for by a doctor with the same ethnic background [ 6 ]. Takeshita et al. [ 6 ] proposed this is due to a greater likelihood of mutual understanding of cultural values, beliefs, and preferences and is therefore more likely to cultivate a trusting relationship, leading to accurate diagnosis, treatment adherence and improved patient understanding. As such, ensuring that all trainees are justly educated and assessed throughout their training may contribute to improving patient care by diversifying the consultant body.

Surgery is well known to have its own specific culture, language, and social rules which are unique even within the world of medicine [ 7 , 8 ]. Through training, graduates develop into surgeons, distinct from other physicians and practitioners [ 9 ]. As such, research conducted in other medical domains is not automatically applicable to surgery, and behavioural interventions focused on reducing or eliminating bias in training need to be tailored specifically to surgical settings.

Consequently, it’s important that the surgical community asks the questions:

Does DA exist in postgraduate surgical training, and to what extent?

Why does DA occur?

What groups or assessments are under-researched?

How can we apply this knowledge, or acquire new knowledge, to provide equity for trainees?

The following scoping review hopes to provide the surgical community with robust answers for future of surgical training.

Aims and research question

The aim of this scoping review is to understand the breadth of research about the presence of DA in postgraduate surgical education and to determine themes pertaining to causes of inequalities. A scoping review was chosen to provide a means to map the available literature, including published peer-reviewed primary research and grey literature.

Following the methodological framework set out by Arksey and O’Malley [ 10 ], our research was intended to characterise the literature addressing DA in HST, including Ophthalmology, Obstetrics & Gynaecology (O&G). We included literature from English-language speaking countries, including the UK and USA.

Search strategy

We used search terms tailored to our target population characteristics (e.g., gender, ethnicity), concept (i.e., DA) and context (i.e., assessment in postgraduate surgical education). Medline and Embase were searched with the assistance of a research librarian, with addition of synonyms. This was conducted in May 2023, and was exported to Microsoft Excel for further review. The reference lists of included articles were also searched to find any relevant data sources that had yet to be considered. In addition, to identify grey literature, a search was performed for the term “differential attainment” and “disparity” on the relevant stakeholders’ websites (See supplemental Table 1 for full listing). Stakeholders were included on the basis of their involvement in governance or training of surgical trainees.

Study selection

To start we excluded conference abstracts that were subsequently published as full papers to avoid duplications ( n  = 337). After an initial screen by title to exclude obviously irrelevant articles, articles were filtered to meet our inclusion and exclusion criteria (Table  1 ). The remaining articles ( n  = 47) were then reviewed in their entirety, with the addition of five reports found in grey literature. Following the screening process, 45 studies were recruited for scoping review (Fig.  1 ).

Charting the data

The extracted data included literature title, authors, year of publication, country of study, study design, population characteristic, case number, context, type of assessment, research question and main findings (Appendix 1). Extraction was performed initially by a single author and then subsequently by a second author to ensure thorough review. Group discussion was conducted in case of any disagreements. As charting occurred, papers were discovered within reference lists of included studies which were eligible for inclusion; these were assimilated into the data charting table and included in the data extraction ( n  = 8).

Collating, summarizing and reporting the results

The included studies were not formally assessed in their quality or risk of bias, consistent with a scoping review approach [ 10 ]. However, group discussion was conducted during charting to aid argumentation and identify themes and trends.

We conducted a descriptive numerical summary to describe the characteristics of included studies. Then thematic analysis was implemented to examine key details and organise the attainment quality and population characteristics based on their description. The coding of themes was an iterative process and involved discussion between authors, to identify and refine codes to group into themes.

We categorised the main themes as gender, ethnicity, country of graduation, individual and family background in education, socioeconomic background, age, and disability. The number of articles in each theme is demonstrated in Table  2 . Data was reviewed and organised into subtopics based on assessment types included: academic achievement (e.g., MRCS, FRCS), assessments for progression (e.g., ARCP), workplace-based assessment (e.g., EPA, feedback), surgical experience (e.g., case volume), and technical skills (e.g., visuo-spatial tasks).

PRISMA flow diagram

44 articles defined the number of included participants (89,399 participants in total; range of participants across individual studies 16–34,755). Two articles reported the number of included studies for their meta-analysis (18 and 63 included articles respectively). Two reports from grey literature did not define the number of participants they included in their analysis. The characteristics of the included articles are displayed in Table  2 .

Growth in published literature on differential attainment over the past 40 years

Academic achievement

In the American Board of Surgery Certifying Exam (ABSCE), Maker [ 11 ] found there to be no significant differences in terms of gender when comparing those who passed on their first attempt and those who did not in general surgery training, a finding supported by Ong et al. [ 12 ]. Pico et al. [ 13 ] reported that in Orthopaedic training, Orthopaedic In-Training Examination (OITE) and American Board of Orthopaedic Surgery (ABOS) Part 1 scores were similar between genders, but that female trainees took more attempts in order to pass. In the UK, two studies reported significantly lower Membership of the Royal College of Surgeons (MRCS) pass rates for female trainees compared to males [ 4 , 14 ]. However, Robinson et al. [ 15 ] presented no significant gender differences in MRCS success rates. A study assessing Fellowship of the Royal College of Surgeons (FRCS) examination results found no significant gender disparities in pass rates [ 16 ]. In MRCOG examination, no significant gender differences were found in Part 1 scores, but women had higher pass rates and scores in Part 2 [ 17 ].

Assessment for Progression

ARCP is the annual process of revalidation that UK doctors must perform to progress through training. A satisfactory progress outcome (“outcome 1”) allows trainees to advance through to the next training year, whereas non-satisfactory outcomes (“2–5”) suggest inadequate progress and recommends solutions, such as further time in training or being released from the training programme. Two studies reported that women received 60% more non-satisfactory outcomes than men [ 16 , 18 ]. In contrast, in O&G men had higher non-satisfactory ARCP outcomes without explicit reasons for this given [ 19 ].

Regarding Milestone evaluations based from the US Accreditation Council for Graduate Medical Education (ACGME), Anderson et al. [ 20 ] reported men had higher ratings of knowledge of diseases at postgraduate year 5 (PGY-5), while women had lower mean score achievements. This was similar to another study finding that men and women had similar competencies at PGY-1 to 3, and that it was only at PGY-5 that women were evaluated lower than men [ 21 ]. However, Kwasny et al. [ 22 ] found no difference in trainers’ ratings between genders, but women self-rated themselves lower. Salles et al. [ 23 ] demonstrated significant improvement in scoring in women following a value-affirmation intervention, while this intervention did not affect men.

Workplace-based Assessment

Galvin et al. [ 24 ] reported better evaluation scores from nurses for PGY-2 male trainees, while females received fewer positive and more negative comments. Gerull et al. [ 25 ] demonstrated men received compliments with superlatives or standout words, whereas women were more likely to receive compliments with mitigating phrases (e.g., excellent vs. quite competent).

Hayward et al. [ 26 ] investigated assessment of attributes of clinical performance (ethics, judgement, technical skills, knowledge and interpersonal skills) and found similar scoring between genders.

Several authors have studied autonomy given to trainees in theatre [ 27 , 28 , 29 , 30 , 31 ]. Two groups found no difference in level of granted autonomy between genders but that women rated lower perceived autonomy on self-evaluation [ 27 , 28 ]. Other studies found that assessors consistently gave female trainees lower autonomy ratings, but only in one paper was this replicated in lower performance scores [ 29 , 30 , 31 ].

Padilla et al. [ 32 ] reported no difference in entrustable professional activity assessment (EPA) levels between genders, yet women rated themselves much lower, which they regarded as evidence of imposter syndrome amongst female trainees. Cooney et al. [ 33 ] found that male trainers scored EPAs for women significantly lower than men, while female trainers rated both genders similarly. Conversely, Roshan et al. [ 34 ] found that male assessors were more positive in feedback comments to female trainees than male trainees, whereas they also found that comments from female assessors were comparable for each gender.

Surgical Experience

Gong et al. [ 35 ] found significantly fewer cataract operations were performed by women in ophthalmology residency programmes, which they suggested could be due to trainers being more likely to give cases to male trainees. Female trainees also participated in fewer robotic colorectal procedures, with less operative time on the robotic console afforded [ 36 ]. Similarly, a systematic review highlighted female trainees in various specialties performed fewer cases per week and potentially had limited access to training facilities [ 37 ]. Eruchalu et al. [ 38 ] found that female trainees performed fewer cases, that is, until gender parity was reached, after which case logs were equivalent.

Technical skills

Antonoff et al. [ 39 ] found higher scores for men in coronary anastomosis skills, with women receiving more “fail” assessments. Dill-Macky et al. [ 40 ] analysed laparoscopic skill assessment using blinded videos of trainees and unblinded assessments. While there was no difference in blinded scores between genders, when comparing blinded and unblinded scores individually, assessors were less likely to agree on the scores of women compared to men. However, another study about laparoscopic skills by Skjold-Ødegaard et al. [ 41 ] reported higher performance scores in female residents, particularly when rated by women. The lowest score was shown in male trainees rated by men. While some studies showed disparities in assessment, several studies reported no difference in technical skill assessments (arthroscopic, knot tying, and suturing skills) between genders [ 42 , 43 , 44 , 45 , 46 ].

Several studies investigated trainees’ abilities to complete isolated tasks associated with surgical skills. In laparoscopic tasks, men were initially more skilful in peg transfer and intracorporeal knot tying than women. Following training, the performance was not different between genders [ 47 ]. A study on microsurgical skills reported better initial visual-spatial and perceptual ability in men, while women had better fine motor psychomotor ability. However, these differences were not significant, and all trainees improved significantly after training [ 48 ]. A study by Milam et al. [ 49 ] revealed men performed better in mental rotation tasks and women outperformed in working memory. They hypothesised that female trainees would experience stereotype threat, fear of being reduced to a stereotype, which would impair their performance. They found no evidence of stereotype threat influencing female performance, disproving their hypothesis, a finding supported by Myers et al. [ 50 ].

Ethnicity and country of graduation

Most papers reported ethnicity and country of graduation concurrently, for example grouping trainees as White UK graduates (WUKG), Black and minority ethnicity UK graduates (BME UKG), and international medical graduates (IMG). Therefore, these areas will be addressed together in the following section.

When assessing the likelihood of passing American Board of Surgery (ABS) examinations on first attempt, Yeo et al. [ 51 ] found that White trainees were more likely than non-White. They found that the influence of ethnicity was more significant in the end-of-training certifying exam than in the start-of-training qualifying exam. This finding was corroborated in a study of both the OITE and ABOS certifying exam, suggesting widening inequalities during training [ 52 ].

Two UK-based studies reported significantly higher MRCS pass rates in White trainees compared to BMEs [ 4 , 14 ]. BMEs were less likely to pass MRCS Part A and B, though this was not true for Part A when variations in socioeconomic background were corrected for [ 14 ]. However, Robinson et al. [ 53 ] found no difference in MRCS pass rates based on ethnicity. Another study by Robinson et al. [ 15 ] demonstrated similar pass rates between WUKGs and BME UKGs, but IMGs had significantly lower pass rates than all UKGs. The FRCS pass rates of WUKGs, BME UKGs and IMGs were 76.9%, 52.9%, and 53.9%, respectively, though these percentages were not statistically significantly different [ 16 ].

There was no difference in MRCOG results based on ethnicity, but higher success rates were found in UKGs [ 19 ]. In FRCOphth, WUKGs had a pass rate of 70%, higher than other groups of trainees, with a pass rate of only 45% for White IMGs [ 52 ].

By gathering data from training programmes reporting little to no DA due to ethnicity, Roe et al. [ 54 ] were able to provide a list of factors they felt were protective against DA, such as having supportive supervisors and developing peer networks.

Assessment for progression

RCOphth [ 55 ] found higher rates of satisfactory ARCP outcomes for WUKGs compared to BME UKGs, followed by IMGs. RCOG [ 19 ] discovered higher rates of non-satisfactory ARCP outcomes from non-UK graduates, particularly amongst BMEs and those from the European Economic Area (EEA). Tiffin et al. [ 56 ] considered the difference in experience between UK graduates and UK nationals whose primary medical qualification was gained outside of the UK, and found that the latter were more likely to receive a non-satisfactory ARCP outcome, even when compared to non-UK nationals.

Woolf et al. [ 57 ] explored reasons behind DA by conducting interview studies with trainees. They investigated trainees’ perceptions of fairness in evaluation and found that trainees felt relationships developed with colleagues who gave feedback could affect ARCP results, and might be challenging for BME UKGs and IMGs who have less in common with their trainers.

Workplace-based assessment

Brooks et al. [ 58 ] surveyed the prevalence of microaggressions against Black orthopaedic surgeons during assessment and found 87% of participants experienced some level of racial discrimination during workplace-based performance feedback. Black women reported having more racially focused and devaluing statements from their seniors than men.

Surgical experience

Eruchalu et al. [ 38 ] found that white trainees performed more major surgical cases and more cases as a supervisor than did their BME counterparts.

Dill-Macky et al. [ 40 ] reported no significant difference in laparoscopic surgery assessments between ethnicities.

Individual and family background in education

Two studies [ 4 , 16 ] concentrated on educational background, considering factors such as parental occupation and attendance of a fee-paying school. MRCS part A pass rate was significantly higher for trainees for whom Medicine was their first Degree, those with university-educated parents, higher POLAR (Participation In Local Areas classification group) quintile, and those from fee-paying schools. Higher part B pass rate was associated with graduating from non-Graduate Entry Medicine programmes and parents with managerial or professional occupations [ 4 ]. Trainees with higher degrees were associated with an almost fivefold increase in FRCS success and seven times more scientific publications than their counterparts [ 16 ].

Socioeconomic background

Two studies used Index of Multiple Deprivation quintile, the official measure of relative deprivation in England based on geographical areas for grading socioeconomic level. The area was defined at the time of medical school application. Deprivation quintiles (DQ) were calculated, ranging from DQ1 (most deprived) to DQ5 (least deprived) [ 4 , 14 ].

Trainees with history of less deprivation were associated with higher MRCS part A pass rate. More success in part B was associated with history of no requirement for income support and less deprived areas [ 4 ]. Trainees from DQ1 and DQ2 had lower pass rates and higher number of attempts to pass [ 14 ]. A general trend of better outcomes in examination was found from O&G trainees in less deprived quintiles [ 19 ].

Trainees from DQ1 and DQ2 received significantly more non-satisfactory ARCP outcomes (24.4%) than DQ4 and DQ5 (14.2%) [ 14 ].

Trainees who graduated at age less than 29 years old were more likely to pass MRCS than their counterparts [ 4 ].

Authors [ 18 , 56 ] found that older trainees received more non-satisfactory ARCP outcomes. Likewise, there was higher percentage of non-satisfactory ARCP outcomes in O&G trainees aged over 45 compared with those aged 25–29 regardless of gender [ 19 ].

Trainees with disability had significantly lower pass rates in MRCS part A compared to candidates without disability. However, the difference was not significant for part B [ 59 ].

What have we learnt from the literature?

It is heartening to note the recent increase in interest in DA (27 studies in the last 4 years, compared to 26 in the preceding 40) (Fig.  2 ). The vast majority (77%) of studies are quantitative, based in the US or UK (89%), focus on gender (85%) and relate to clinical assessments (51%) rather than examination results. Therefore, the surgical community has invested primarily in researching the experience of women in the USA and UK.

Interestingly, a report by RCOG [ 19 ] showed that men were more likely to receive non-satisfactory ARCP outcomes than women, and a study by Rushd et al. [ 17 ] found that women were more likely to pass part 2 of MRCOG than men. This may be because within O&G men are the “out-group” (a social group or category characterised by marginalisation or exclusion by the dominant cultural group) as 75% of O&G trainees are female [ 60 ].

This contrasts with other specialities in which men are the in-group and women are seen to underperform. Outside of O&G, in comparison to men, women are less likely to pass MRCS [ 4 , 14 ], receive satisfactory ARCP outcome [ 16 , 18 ], or receive positive feedback [ 24 ], whilst not performing the same number of procedures as men [ 34 , 35 ]. This often leads to poor self-confidence in women [ 32 ], which can then worsen performance [ 21 ].

It proves difficult to comment on DA for many groups due to a lack of evidence. The current research suggests that being older, having a disability, graduate entry to medicine, low parental education, and living in a lower socioeconomic area at the time of entering medical school are all associated with lower MRCS pass rates. Being older and having a lower socioeconomic background are also associated with non-satisfactory ARCP outcomes, slowing progression through training.

These characteristics may provide a compounding negative effect – for example having a previous degree will automatically make a trainee older, and living in a lower socioeconomic area makes it more likely their parents will have a non-professional job and not hold a higher degree. When multiple protected characteristics interact to produce a compounded negative effect for a person, it is often referred to as “intersectional discrimination” or “intersectionality” [ 61 ]. This is a concept which remains underrepresented in the current literature.

The literature is not yet in agreement over the presence of DA due to ethnicity. There are many studies that report perceived discrimination, however the data for exam and clinical assessment outcomes is equivocal. This may be due to the fluctuating nature of in-groups and out-groups, and multiple intersecting characteristics. Despite this, the lived experience of BME surgeons should not be ignored and requires further investigation.

What are the gaps in the literature?

The overwhelming majority of literature exploring DA addresses issues of gender, ethnicity or country of medical qualification. Whilst bias related to these characteristics is crucial to recognise, studies into other protected characteristics are few and far between. The only paper on disability reported striking differences in attainment between disabled and non-disabled registrars [ 59 ]. There has also been increased awareness about neurodiversity amongst doctors and yet an exploration into the experience of neurodiverse surgeons and their progress through training has yet to be published [ 62 ].

The implications of being LGBTQ + in surgical training have not been recognised nor formally addressed in the literature. Promisingly, the experiences of LGBTQ + medical students have been recognised at an undergraduate level, so one can hope that this will be translated into postgraduate education [ 63 , 64 ]. While this is deeply entwined with experiences of gender discrimination, it is an important characteristic that the surgical community would benefit from addressing, along with disability. To a lesser extent, the effect of socioeconomic background and age have also been overlooked.

Characterising trainees for the purpose of research

Ethnicity is deeply personal, self-defined, and may change over time as personal identity evolves, and therefore arbitrarily grouping diverse ethnic backgrounds is unlikely to capture an accurate representation of experiences. There are levels of discrimination even within minority groups; colourism in India means dark-skinned Indians will experience more discrimination than light-skinned Indians, even from those within in their own ethnic group [ 65 ]. Therefore, although the studies included in the scoping review accepted self-definitions of ethnicity, this is likely not enough to fully capture the nuances of bias and discrimination present in society. For example, Ellis et al. [ 4 ] grouped participants as “White”, “Mixed”, “Asian”, “Black” and “Other”, however they could have also assigned a skin tone value such as the NIS Skin Colour Scale [ 66 ], thus providing more detail.

Ethnicity is more than genetic heritage; it is also cultural expression. The experience of an IMG in UK postgraduate training will differ from that of a UKG, an Indian UKG who grew up in India, and an Indian UKG who grew up in the UK. These are important distinctions which are noted in the literature (e.g. by Woolf et al., 2016 [ 57 ]) however some do not distinguish between ethnicity and graduate status [ 15 ] and none delve into an individual’s cultural expression (e.g., clothing choice) and how this affects the perception of their assessors.

Reasons for DA

Despite the recognition of inequalities in all specialties of surgery, there is a paucity of data explicitly addressing why DA occurs. Reasons behind the phenomenon must be explored to enable change and eliminate biases. Qualitative research is more attuned to capturing the complexities of DA through observation or interview-based studies. Currently most published data is quantitative, and relies on performance metrics to demonstrate the presence of DA while ignoring the causes. Promisingly, there are a gradually increasing number of qualitative, predominantly interview-based, studies (Fig.  2 ).

To create a map of DA in all its guises, an analysis of the themes reported to be contributory to its development is helpful. In our review of the literature, four themes have been identified:

Training culture

In higher surgical training, for there to be equality in outcomes, there needs to be equity in opportunities. Ellis et al. [ 4 ] recognised that variation in training experiences, such as accessibility of supportive peers and senior role models, can have implications on attainment. Trainees would benefit from targeted support at times of transition, such as induction or at examinations, and it may be that currently the needs of certain groups are being met before others, reinforcing differential attainment [ 4 ].

Experience of assessment

Most literature in DA relates to the presence (or lack of) an attainment gap in assessments, such as ARCP or MRCS. It is assumed that these assessments of trainee development are objective and free of bias, and indeed several authors have described a lack of bias in these high-stakes examinations (e.g., Ong et al., 2019 [ 12 ]; Robinson et al., 2019 [ 53 ]). However, in some populations, such as disabled trainees, there are differences in attainment [ 59 ]. This is demonstrated despite legislation requiring professional bodies to make reasonable adjustments to examinations for disabled candidates, such as additional time, text formatting amendments, or wheelchair-accessible venues [ 67 ]. Therefore it would be beneficial to investigate the implementation of these adjustments across higher surgical examinations and identify any deficits.

Social networks

Relationships between colleagues may influence DA in multiple ways. Several studies identified that a lack of a relatable and inspiring mentor may explain why female or BME doctors fail to excel in surgery [ 4 , 55 ]. Certain groups may receive preferential treatment due to their perceived familiarity to seniors [ 35 ]. Robinson et al. [ 15 ] recognised that peer-to-peer relationships were also implicated in professional development, and the lack thereof could lead to poor learning outcomes. Therefore, a non-discriminatory culture and inclusion of trainees within the social network of training is posited as beneficial.

Personal characteristics

Finally, personal factors directly related to protected characteristics have been suggested as a cause of DA. For example, IMGs may perform worse in examinations due to language barriers, and those from disadvantaged backgrounds may have less opportunity to attend expensive courses [ 14 , 16 ]. Although it is impossible to exclude these innate deficits from training, we may mitigate their influence by recognising their presence and providing solutions.

The causes of DA may also be grouped into three levels, as described by Regan de Bere et al. [ 68 ]: macro (the implications of high-level policy), meso (focusing on institutional or working environments) and micro (the influence of individual factors). This can intersect with the four themes identified above, as training culture can be enshrined at both an institutional and individual level, influencing decisions that relate to opportunities for trainees, or at a macro level, such as in the decisions made on nationwide recruitment processes. These three levels can be used to more deeply explore each of the four themes to enrich the discovery of causes of DA.

Discussions outside of surgery

Authors in General Practice (e.g., Unwin et al., 2019 [ 69 ]; Pattinson et al., 2019 [ 70 ]), postgraduate medical training (e.g., Andrews, Chartash, and Hay, 2021 [ 71 ]), and undergraduate medical education (e.g., Yeates et al., 2017 [ 72 ]; Woolf et al., 2013 [ 73 ]) have published more extensively in the aetiology of DA. A study by Hope et al. [ 74 ] evaluating the bias present in MRCP exams used differential item functioning to identify individual questions which demonstrated an attainment gap between male and female and Caucasian and non-Caucasian medical trainees. Conclusions drawn about MRCP Part 1 examinations may be generalisable to MRCS Part A or FRCOphth Part 1: they are all multiple-choice examinations testing applied basic science and usually taken within the first few years of postgraduate training. Therefore it is advisable that differential item functioning should also be applied to these examinations. However, it is possible that findings in some subspecialities may not be generalisable to others, as training environments can vary profoundly. The RCOphth [ 55 ] reported that in 2021, 53% of ophthalmic trainees identified as male, whereas in Orthopaedics 85% identified as male, suggesting different training environments [ 5 ]. It is useful to identify commonalities of DA between surgical specialties and in the wider scope of medical training.

Limitations of our paper

Firstly, whilst aiming to provide a review focussed on the experience of surgical trainees, four papers contained data about either non-surgical trainees or medical students. It is difficult to draw out the surgeons from this data and therefore it is possible that there are issues with generalisability. Furthermore, we did not consider the background of each paper’s authors, as their own lived experience of attainment gap could form the lens through which they commented on surgical education, colouring their interpretation. Despite intending to include as many protected characteristics as possible, inevitably there will be lived experiences missed. Lastly, the experience of surgical trainees outside of the English-speaking world were omitted. No studies were found that originated outside of Europe or North America and therefore the presence or characteristics of DA outside of this area cannot be assumed.

Experiences of inequality in surgical assessment are prevalent in all surgical subspecialities. In order to further investigate DA, researchers should ensure all protected characteristics are considered - and how these interact - to gain insight into intersectionality. Given the paucity of current evidence, particular focus should be given to the implications of disability, and specifically neurodiversity, in progress through training as they are yet to be explored in depth. In defining protected characteristics, future authors should be explicit and should avoid generalisation of cultural backgrounds to allow authentic appreciation of attainment gap. Few authors have considered the driving forces between bias in assessment and DA, and therefore qualitative studies should be prioritised to uncover causes for and protective factors against DA. Once these influences have been identified, educational designers can develop new assessment methods that ensure equity across surgical trainees.

Data availability

All data provided during this study are included in the supplementary information files.

Abbreviations

Accreditation Council for Graduate Medical Education

American Board of Orthopaedic Surgery

American Board of Surgery

American Board of Surgery Certifying Exam

Annual Review of Competence Progression

Black, Asian, and Minority Ethnicity

Council on Resident Education in Obstetrics and Gynecology

Differential Attainment

Deprivation Quintile

European Economic Area

Entrustable Professional Activities

Fellowship of The Royal College of Ophthalmologists

Fellow of the Royal College of Surgeons

General Medical Council

Higher Surgical Training

International Medical Graduate

In-Training Evaluation Report

Member of the Royal College of Obstetricians and Gynaecologists

Member of the Royal College of Physicians

Member of the Royal College of Surgeons

Obstetrics and Gynaecology

Orthopaedic In-Training Examination

Participation In Local Areas

Postgraduate Year

The Royal College of Ophthalmologists

The Royal College of Obstetricians and Gynaecologists

The Royal College of Surgeons of England

United Kingdom Graduate

White United Kingdom Graduate

Joseph JP, Joseph AO, Jayanthi NVG, et al. BAME Underrepresentation in Surgery Leadership in the UK and Ireland in 2020: An Uncomfortable Truth. The Bulletin of the Royal College of Surgeons of England. 2020; 102 (6): 232–33.

Royal College of Surgeons of England. The Royal College – Our Professional Home. An independent review on diversity and inclusion for the Royal College of Surgeons of England. Review conducted by Baroness Helena Kennedy QC. RCS England. 2021.

Sarafidou K, Greatorex R. Surgical workforce: planning today for the workforce of the future. Bull Royal Coll Surg Engl. 2011;93(2):48–9. https://doi.org/10.1308/147363511X552575 .

Article   Google Scholar  

Ellis R, Brennan P, Lee AJ, et al. Differential attainment at MRCS according to gender, ethnicity, age and socioeconomic factors: a retrospective cohort study. J R Soc Med. 2022;115(7):257–72. https://doi.org/10.1177/01410768221079018 .

Hope C, Humes D, Griffiths G, et al. Personal Characteristics Associated with Progression in Trauma and Orthopaedic Specialty Training: A Longitudinal Cohort Study.Journal of Surgical Education 2022; 79 (1): 253–59. doi:10.1016/j.jsurg.2021.06.027.

Takeshita J, Wang S, Loren AW, et al. Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Network Open. 2022; 3(11). doi:10.1001/jamanetworkopen.2020.24583.

Katz, P. The Scalpel’s Edge: The Culture of Surgeons. Allyn and Bacon, 1999.

Tørring B, Gittell JH, Laursen M, et al. (2019) Communication and relationship dynamics in surgical teams in the operating room: an ethnographic study. BMC Health Services Research. 2019;19, 528. doi:10.1186/s12913-019-4362-0.

Veazey Brooks J & Bosk CL. (2012) Remaking surgical socialization: work hour restrictions, rites of passage, and occupational identity. Social Science & Medicine. 2012;75(9):1625-32. doi: 10.1016/j.socscimed.2012.07.007.

Arksey H & OʼMalley L. Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology. 2005;8(1), 19–32.

Maker VK, Marco MZ, Dana V, et al. Can We Predict Which Residents Are Going to Pass/Fail the Oral Boards? Journal of Surgical Education. 2012;69 (6): 705–13.

Ong TQ, Kopp JP, Jones AT, et al. Is there gender Bias on the American Board of Surgery general surgery certifying examination? J Surg Res. 2019;237:131–5. https://doi.org/10.1016/j.jss.2018.06.014 .

Pico K, Gioe TJ, Vanheest A, et al. Do men outperform women during orthopaedic residency training? Clin Orthop Relat Res. 2010;468(7):1804–8. https://doi.org/10.1007/s11999-010-1318-4 .

Vinnicombe Z, Little M, Super J, et al. Differential attainment, socioeconomic factors and surgical training. Ann R Coll Surg Engl. 2022;104(8):577–82. https://doi.org/10.1308/rcsann.2021.0255 .

Robinson DBT, Hopkins L, James OP, et al. Egalitarianism in surgical training: let equity prevail. Postgraduate Medical Journal. 2020;96 (1141), 650–654. doi:10.1136/postgradmedj-2020-137563.

Luton OW, Mellor K, Robinson DBT, et al. Differential attainment in higher surgical training: scoping pan-specialty spectra. Postgraduate Medical Journal. 2022;99(1174),849–854. doi:10.1136/postgradmedj-2022-141638.

Rushd S, Landau AB, Khan JA, Allgar V & Lindow SW. An analysis of the performance of UK medical graduates in the MRCOG Part 1 and Part 2 written examinations. Postgraduate Medical Journal. 2012;88 (1039), 249–254. doi:10.1136/postgradmedj-2011-130479.

Hope C, Lund J, Griffiths G, et al. Differences in ARCP outcome by surgical specialty: a longitudinal cohort study. Br J Surg. 2021;108. https://doi.org/10.1093/bjs/znab282.051 .

Royal College of Obstetricians and Gynaecologists. Report Differential Attainment 2019. https://www.rcog.org.uk/media/jscgfgwr/differential-attainment-tef-report-2019.pdf [Last accessed 28/12/23].

Anderson JE, Zern NK, Calhoun KE, et al. Assessment of Potential Gender Bias in General Surgery Resident Milestone Evaluations. JAMA Surgery. 2022;157 (12), 1164–1166. doi:10.1001/jamasurg.2022.3929.

Landau SI, Syvyk S, Wirtalla C, et al. Trainee Sex and Accreditation Council for Graduate Medical Education Milestone Assessments during general surgery residency. JAMA Surg. 2021;156(10):925–31. https://doi.org/10.1001/jamasurg.2021.3005 .

Kwasny L, Shebrain S, Munene G, et al. Is there a gender bias in milestones evaluations in general surgery residency training? Am J Surg. 2021;221(3):505–8. https://doi.org/10.1016/j.amjsurg.2020.12.020 .

Salles A, Mueller CM & Cohen GL. A Values Affirmation Intervention to Improve Female Residents’ Surgical Performance. Journal of Graduate Medical Education. 2016;8 (3), 378–383. doi:10.4300/JGME-D-15-00214.1.

Galvin S, Parlier A, Martino E, et al. Gender Bias in nurse evaluations of residents in Obstetrics and Gynecology. Obstet Gynecol. 2015;126(7S–12S). https://doi.org/10.1097/AOG.0000000000001044 .

Gerull KM, Loe M, Seiler K, et al. Assessing gender bias in qualitative evaluations of surgical residents. Am J Surg. 2019;217(2):306–13. https://doi.org/10.1016/j.amjsurg.2018.09.029 .

Hayward CZ, Sachdeva A, Clarke JR. Is there gender bias in the evaluation of surgical residents? Surgery. 1987;102(2):297–9.

Google Scholar  

Cookenmaster C, Shebrain S, Vos D, et al. Gender perception bias of operative autonomy evaluations among residents and faculty in general surgery training. Am J Surg. 2021;221(3):515–20. https://doi.org/10.1016/j.amjsurg.2020.11.016 .

Olumolade OO, Rollins PD, Daignault-Newton S, et al. Closing the Gap: Evaluation of Gender Disparities in Urology Resident Operative Autonomy and Performance.Journal of Surgical Education.2022;79 (2), 524–530. doi.org/10.1016/j.jsurg.2021.10.010.

Chen JX, Chang EH, Deng F, et al. Autonomy in the Operating Room: A Multicenter Study of Gender Disparities During Surgical Training. Journal of Graduate Medical Education. 2021;13(5), 666–672. doi: 10.4300/JGME-D-21-00217.1.

Meyerson SL, Sternbach JM, Zwischenberger JB, & Bender EM. The Effect of Gender on Resident Autonomy in the Operating room. Journal of Surgical Education. 2017. 74(6), e111–e118. doi.org/10.1016/j.jsurg.2017.06.014.

Hoops H, Heston A, Dewey E, et al. Resident autonomy in the operating room: Does gender matter? The AmericanJournalofSurgery. 2019; 217(2), 301–305. doi.org/10.1016/j.amjsurg.2018.12.023.

Padilla EP, Stahl CC, Jung SA, et al. Gender Differences in Entrustable Professional Activity Evaluations of General Surgery Residents. Annals of Surgery. 2022;275 (2), 222–229. doi:10.1097/SLA.0000000000004905.

Cooney CM, Aravind P, Hultman CS, et al. An Analysis of Gender Bias in Plastic Surgery Resident Assessment. Journal of Graduate Medical Education. 2021;13 (4), 500–506. doi:10.4300/JGME-D-20-01394.1.

Roshan A, Farooq A, Acai A, et al. The effect of gender dyads on the quality of narrative assessments of general surgery trainees. The American Journal of Surgery. 2022; 224 (1A), 179–184. doi.org/10.1016/j.amjsurg.2021.12.001.

Gong D, Winn BJ, Beal CJ, et al. Gender Differences in Case Volume Among Ophthalmology Residents. Archives of Ophthalmology. 2019;137 (9), 1015–1020. doi:10.1001/jamaophthalmol.2019.2427.

Foley KE, Izquierdo KM, von Muchow MG, et al. Colon and Rectal Surgery Robotic Training Programs: An Evaluation of Gender Disparities. Diseases of the Colon and Rectum. 2020; 63(7), 974–979. doi.org/10.1097/DCR.0000000000001625.

Ali A, Subhi Y, Ringsted C et al. Gender differences in the acquisition of surgical skills: a systematic review. Surgical Endoscopy. 2015;29 (11), 3065–3073. doi:10.1007/s00464-015-4092-2.

Eruchalu CN, He K, Etheridge JC, et al. Gender and Racial/Ethnic Disparities in Operative Volumes of Graduating General Surgery Residents.The Journal of Surgical Research. 2022; 279, 104–112. doi.org/10.1016/j.jss.2022.05.020.

Antonoff MB, Feldman H, Luc JGY, et al. Gender Bias in the Evaluation of Surgical Performance: Results of a Prospective Randomized Trial. Annals of Surgery. 2023;277 (2), 206–213. doi:10.1097/SLA.0000000000005015.

Dill-Macky A, Hsu C, Neumayer LA, et al. The Role of Implicit Bias in Surgical Resident Evaluations. Journal of Surgical Education. 2022;79 (3), 761–768. doi:10.1016/j.jsurg.2021.12.003.

Skjold-Ødegaard B, Ersdal HL, Assmus J et al. Comparison of Performance Score for Female and Male Residents in General Surgery Doing Supervised Real-Life Laparoscopic Appendectomy: Is There a Norse Shield-Maiden Effect? World Journal of Surgery. 2021;45 (4), 997–1005. doi:10.1007/s00268-020-05921-4.

Leape CP, Hawken JB, Geng X, et al. An investigation into gender bias in the evaluation of orthopedic trainee arthroscopic skills. Journal of Shoulder and Elbow Surgery. 2022;31 (11), 2402–2409. doi:10.1016/j.jse.2022.05.024.

Vogt VY, Givens VM, Keathley CA, et al. Is a resident’s score on a videotaped objective structured assessment of technical skills affected by revealing the resident’s identity? American Journal of Obstetrics and Gynecology. 2023;189 (3), 688–691. doi:10.1067/S0002-9378(03)00887-1.

Fjørtoft K, Konge L, Christensen J et al. Overcoming Gender Bias in Assessment of Surgical Skills. Journal of Surgical Education. 2022;79 (3), 753–760. doi:10.1016/j.jsurg.2022.01.006.

Grantcharov TP, Bardram L, Funch-Jensen P, et al. Impact of Hand Dominance, Gender, and Experience with Computer Games on Performance in Virtual Reality Laparoscopy. Surgical Endoscopy 2003;17 (7): 1082–85.

Rosser Jr JC, Rosser LE & Savalgi RS. Objective Evaluation of a Laparoscopic Surgical Skill Program for Residents and Senior Surgeons. Archives of Surgery. 1998; 133 (6): 657–61.

White MT & Welch K. Does gender predict performance of novices undergoing Fundamentals of Laparoscopic Surgery (FLS) training? The American Journal of Surgery. 2012;203 (3), 397–400. doi:10.1016/j.amjsurg.2011.09.020.

Nugent E, Joyce C, Perez-Abadia G, et al. Factors influencing microsurgical skill acquisition during a dedicated training course. Microsurgery. 2012;32 (8), 649–656. doi:10.1002/micr.22047.

Milam LA, Cohen GL, Mueller C et al. Stereotype threat and working memory among surgical residents. The American Journal of Surgery. 2018;216 (4), 824–829. doi:10.1016/j.amjsurg.2018.07.064.

Myers SP, Dasari M, Brown JB, et al. Effects of Gender Bias and Stereotypes in Surgical Training: A Randomized Clinical Trial. JAMA Surgery. 2020; 155(7), 552–560. doi.org/10.1001/jamasurg.2020.1127.

Yeo HL, Patrick TD, Jialin M, et al. Association of Demographic and Program Factors With American Board of Surgery Qualifying and Certifying Examinations Pass Rates. JAMA Surgery 2020; 155 (1): 22–30. doi:0.1001/jamasurg.2019.4081.

Foster N, Meghan P, Bettger JP, et al. Objective Test Scores Throughout Orthopedic Surgery Residency Suggest Disparities in Training Experience. Journal of Surgical Education 2021;78 (5): 1400–1405. doi:10.1016/j.jsurg.2021.01.003.

Robinson DBT, Hopkins L, Brown C, et al. Prognostic Significance of Ethnicity on Differential Attainment in Core Surgical Training (CST). Journal of the American College of Surgeons. 2019;229 (4), e191. doi:10.1016/j.jamcollsurg.2019.08.1254.

Roe V, Patterson F, Kerrin M, et al. What supported your success in training? A qualitative exploration of the factors associated with an absence of an ethnic attainment gap in post-graduate specialty training. General Medical Council. 2019. https://www.gmc-uk.org/-/media/documents/gmc-da-final-report-success-factors-in-training-211119_pdf-80914221.pdf [Last accessed 28/12/23].

Royal College of Ophthalmologists. Data on Differential attainment in ophthalmology and monitoring equality, diversity, and inclusion: Recommendations to the RCOphth. London, Royal College of Ophthalmologists. 2022. https://www.rcophth.ac.uk/wp-content/uploads/2023/01/Differential-Attainment-Report-2022.pdf [Last accessed 28/12/23].

Tiffin PA, Orr J, Paton LW, et al. UK nationals who received their medical degrees abroad: selection into, and subsequent performance in postgraduate training: a national data linkage study. BMJ Open. 2018;8:e023060. doi: 10.1136/bmjopen-2018-023060.

Woolf K, Rich A, Viney R, et al. Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study. BMJ Open. 2016;6 (11), e013429. doi:10.1136/bmjopen-2016-013429.

Brooks JT, Porter SE, Middleton KK, et al. The Majority of Black Orthopaedic Surgeons Report Experiencing Racial Microaggressions During Their Residency Training. Clinical Orthopaedics and Related Research. 2023;481 (4), 675–686. doi:10.1097/CORR.0000000000002455.

Ellis R, Cleland J, Scrimgeour D, et al. The impact of disability on performance in a high-stakes postgraduate surgical examination: a retrospective cohort study. Journal of the Royal Society of Medicine. 2022;115 (2), 58–68. doi:10.1177/01410768211032573.

Royal College of Obstetricians & Gynaecologists. RCOGWorkforceReport2022. Available at: https://www.rcog.org.uk/media/fdtlufuh/workforce-report-july-2022-update.pdf [Last accessed 28/12/23].

Crenshaw KW. On Intersectionality: Essential Writings. Faculty Books. 2017; 255.

Brennan CM & Harrison W. The Dyslexic Surgeon. The Bulletin of the Royal College of Surgeons of England. 2020;102 (3): 72–75. doi:10.1308/rcsbull.2020.72.

Toman L. Navigating medical culture and LGBTQ identity. Clinical Teacher. 2019;16: 335–338. doi:10.1111/tct.13078.

Torales J, Castaldelli-Maia JM & Ventriglio A. LGBT + medical students and disclosure of their sexual orientation: more than in and out of the closet. International Review of Psychiatry. 2022;34:3–4, 402–406. doi:10.1080/09540261.2022.2101881.

Guda VA & Kundu RV. India’s Fair Skin Phenomena. SKINmed. 2021;19(3), 177–178.

Massey D & Martin JA. The NIS skin color scale. Princeton University Press. 2003.

Intercollegiate Committee for Basic Surgical Examinations.AccessArrangementsandReasonableAdjustmentsPolicyforCandidateswithaDisabilityorSpecificLearningdifficulty. 2020. https://www.intercollegiatemrcsexams.org.uk/-/media/files/imrcs/mrcs/mrcs-regulations/access-arrangements-and-reasonable-adjustments-january-2020.pdf [Last accessed 28/12/23].

Regan de Bere S, Nunn S & Nasser M. Understanding differential attainment across medical training pathways: A rapid review of the literature. General Medical Council. 2015. https://www.gmc-uk.org/-/media/documents/gmc-understanding-differential-attainment_pdf-63533431.pdf [Last accessed 28/12/23].

Unwin E, Woolf K, Dacre J, et al. Sex Differences in Fitness to Practise Test Scores: A Cohort Study of GPs. The British Journal of General Practice: The Journal of the Royal College of General Practitioners. 2019; 69 (681): e287–93. doi:10.3399/bjgp19X701789.

Pattinson J, Blow C, Sinha B et al. Exploring Reasons for Differences in Performance between UK and International Medical Graduates in the Membership of the Royal College of General Practitioners Applied Knowledge Test: A Cognitive Interview Study. BMJ Open. 2019;9 (5): e030341. doi:10.1136/bmjopen-2019-030341.

Andrews J, Chartash D & Hay S. Gender Bias in Resident Evaluations: Natural Language Processing and Competency Evaluation. Medical Education. 2021;55 (12): 1383–87. doi:10.1111/medu.14593.

Yeates P, Woolf K, Benbow E, et al. A Randomised Trial of the Influence of Racial Stereotype Bias on Examiners’ Scores, Feedback and Recollections in Undergraduate Clinical Exams. BMC Medicine 2017;15 (1): 179. doi:10.1186/s12916-017-0943-0.

Woolf K, McManus IC, Potts HWW et al. The Mediators of Minority Ethnic Underperformance in Final Medical School Examinations. British Journal of Educational Psychology. 2013; 83 (1): 135–59. doi:10.1111/j.2044-8279.2011.02060.x.

Hope D, Adamson K, McManus IC, et al. Using Differential Item Functioning to Evaluate Potential Bias in a High Stakes Postgraduate Knowledge Based Assessment. BMC Medical Education. 2018;18 (1): 64. doi:10.1186/s12909-018-1143-0.

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Rebecca L. Jones, Suwimol Prusmetikul & Sarah Whitehorn

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RJ, SP and SW conceived the study. RJ carried out the search. RJ, SP and SW reviewed and appraised articles. RJ, SP and SW extracted data and synthesized results from articles. RJ, SP and SW prepared the original draft of the manuscript. RJ and SP prepared Figs. 1 and 2. All authors reviewed and edited the manuscript and agreed to the final version.

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Jones, R.L., Prusmetikul, S. & Whitehorn, S. Differential attainment in assessment of postgraduate surgical trainees: a scoping review. BMC Med Educ 24 , 597 (2024). https://doi.org/10.1186/s12909-024-05580-2

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Received : 27 February 2024

Accepted : 20 May 2024

Published : 30 May 2024

DOI : https://doi.org/10.1186/s12909-024-05580-2

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