what is data analysis and discussion in research

• Skip to main content
• Skip to primary sidebar
• Skip to footer
• QuestionPro

• Solutions Industries Gaming Automotive Sports and events Education Government Travel & Hospitality Financial Services Healthcare Cannabis Technology Use Case NPS+ Communities Audience Contactless surveys Mobile LivePolls Member Experience GDPR Positive People Science 360 Feedback Surveys
• Resources Blog eBooks Survey Templates Case Studies Training Help center

Home Market Research

Data Analysis in Research: Types & Methods

Content Index

Why analyze data in research?

Types of data in research, finding patterns in the qualitative data, methods used for data analysis in qualitative research, preparing data for analysis, methods used for data analysis in quantitative research, considerations in research data analysis, what is data analysis in research.

Definition of research in data analysis: According to LeCompte and Schensul, research data analysis is a process used by researchers to reduce data to a story and interpret it to derive insights. The data analysis process helps reduce a large chunk of data into smaller fragments, which makes sense. 

Three essential things occur during the data analysis process — the first is data organization . Summarization and categorization together contribute to becoming the second known method used for data reduction. It helps find patterns and themes in the data for easy identification and linking. The third and last way is data analysis – researchers do it in both top-down and bottom-up fashion.

LEARN ABOUT: Research Process Steps

On the other hand, Marshall and Rossman describe data analysis as a messy, ambiguous, and time-consuming but creative and fascinating process through which a mass of collected data is brought to order, structure and meaning.

We can say that “the data analysis and data interpretation is a process representing the application of deductive and inductive logic to the research and data analysis.”

Researchers rely heavily on data as they have a story to tell or research problems to solve. It starts with a question, and data is nothing but an answer to that question. But, what if there is no question to ask? Well! It is possible to explore data even without a problem – we call it ‘Data Mining’, which often reveals some interesting patterns within the data that are worth exploring.

Irrelevant to the type of data researchers explore, their mission and audiences’ vision guide them to find the patterns to shape the story they want to tell. One of the essential things expected from researchers while analyzing data is to stay open and remain unbiased toward unexpected patterns, expressions, and results. Remember, sometimes, data analysis tells the most unforeseen yet exciting stories that were not expected when initiating data analysis. Therefore, rely on the data you have at hand and enjoy the journey of exploratory research. 

Create a Free Account

Every kind of data has a rare quality of describing things after assigning a specific value to it. For analysis, you need to organize these values, processed and presented in a given context, to make it useful. Data can be in different forms; here are the primary data types.

• Qualitative data: When the data presented has words and descriptions, then we call it qualitative data . Although you can observe this data, it is subjective and harder to analyze data in research, especially for comparison. Example: Quality data represents everything describing taste, experience, texture, or an opinion that is considered quality data. This type of data is usually collected through focus groups, personal qualitative interviews , qualitative observation or using open-ended questions in surveys.
• Quantitative data: Any data expressed in numbers of numerical figures are called quantitative data . This type of data can be distinguished into categories, grouped, measured, calculated, or ranked. Example: questions such as age, rank, cost, length, weight, scores, etc. everything comes under this type of data. You can present such data in graphical format, charts, or apply statistical analysis methods to this data. The (Outcomes Measurement Systems) OMS questionnaires in surveys are a significant source of collecting numeric data.
• Categorical data: It is data presented in groups. However, an item included in the categorical data cannot belong to more than one group. Example: A person responding to a survey by telling his living style, marital status, smoking habit, or drinking habit comes under the categorical data. A chi-square test is a standard method used to analyze this data.

Learn More : Examples of Qualitative Data in Education

Data analysis in qualitative research

Data analysis and qualitative data research work a little differently from the numerical data as the quality data is made up of words, descriptions, images, objects, and sometimes symbols. Getting insight from such complicated information is a complicated process. Hence it is typically used for exploratory research and data analysis .

Although there are several ways to find patterns in the textual information, a word-based method is the most relied and widely used global technique for research and data analysis. Notably, the data analysis process in qualitative research is manual. Here the researchers usually read the available data and find repetitive or commonly used words. 

For example, while studying data collected from African countries to understand the most pressing issues people face, researchers might find  “food”  and  “hunger” are the most commonly used words and will highlight them for further analysis.

LEARN ABOUT: Level of Analysis

The keyword context is another widely used word-based technique. In this method, the researcher tries to understand the concept by analyzing the context in which the participants use a particular keyword.  

For example , researchers conducting research and data analysis for studying the concept of ‘diabetes’ amongst respondents might analyze the context of when and how the respondent has used or referred to the word ‘diabetes.’

The scrutiny-based technique is also one of the highly recommended  text analysis  methods used to identify a quality data pattern. Compare and contrast is the widely used method under this technique to differentiate how a specific text is similar or different from each other. 

For example: To find out the “importance of resident doctor in a company,” the collected data is divided into people who think it is necessary to hire a resident doctor and those who think it is unnecessary. Compare and contrast is the best method that can be used to analyze the polls having single-answer questions types .

Metaphors can be used to reduce the data pile and find patterns in it so that it becomes easier to connect data with theory.

Variable Partitioning is another technique used to split variables so that researchers can find more coherent descriptions and explanations from the enormous data.

LEARN ABOUT: Qualitative Research Questions and Questionnaires

There are several techniques to analyze the data in qualitative research, but here are some commonly used methods,

• Content Analysis:  It is widely accepted and the most frequently employed technique for data analysis in research methodology. It can be used to analyze the documented information from text, images, and sometimes from the physical items. It depends on the research questions to predict when and where to use this method.
• Narrative Analysis: This method is used to analyze content gathered from various sources such as personal interviews, field observation, and  surveys . The majority of times, stories, or opinions shared by people are focused on finding answers to the research questions.
• Discourse Analysis:  Similar to narrative analysis, discourse analysis is used to analyze the interactions with people. Nevertheless, this particular method considers the social context under which or within which the communication between the researcher and respondent takes place. In addition to that, discourse analysis also focuses on the lifestyle and day-to-day environment while deriving any conclusion.
• Grounded Theory:  When you want to explain why a particular phenomenon happened, then using grounded theory for analyzing quality data is the best resort. Grounded theory is applied to study data about the host of similar cases occurring in different settings. When researchers are using this method, they might alter explanations or produce new ones until they arrive at some conclusion.

LEARN ABOUT: 12 Best Tools for Researchers

Data analysis in quantitative research

The first stage in research and data analysis is to make it for the analysis so that the nominal data can be converted into something meaningful. Data preparation consists of the below phases.

Phase I: Data Validation

Data validation is done to understand if the collected data sample is per the pre-set standards, or it is a biased data sample again divided into four different stages

• Fraud: To ensure an actual human being records each response to the survey or the questionnaire
• Screening: To make sure each participant or respondent is selected or chosen in compliance with the research criteria
• Procedure: To ensure ethical standards were maintained while collecting the data sample
• Completeness: To ensure that the respondent has answered all the questions in an online survey. Else, the interviewer had asked all the questions devised in the questionnaire.

Phase II: Data Editing

More often, an extensive research data sample comes loaded with errors. Respondents sometimes fill in some fields incorrectly or sometimes skip them accidentally. Data editing is a process wherein the researchers have to confirm that the provided data is free of such errors. They need to conduct necessary checks and outlier checks to edit the raw edit and make it ready for analysis.

Phase III: Data Coding

Out of all three, this is the most critical phase of data preparation associated with grouping and assigning values to the survey responses . If a survey is completed with a 1000 sample size, the researcher will create an age bracket to distinguish the respondents based on their age. Thus, it becomes easier to analyze small data buckets rather than deal with the massive data pile.

LEARN ABOUT: Steps in Qualitative Research

After the data is prepared for analysis, researchers are open to using different research and data analysis methods to derive meaningful insights. For sure, statistical analysis plans are the most favored to analyze numerical data. In statistical analysis, distinguishing between categorical data and numerical data is essential, as categorical data involves distinct categories or labels, while numerical data consists of measurable quantities. The method is again classified into two groups. First, ‘Descriptive Statistics’ used to describe data. Second, ‘Inferential statistics’ that helps in comparing the data .

Descriptive statistics

This method is used to describe the basic features of versatile types of data in research. It presents the data in such a meaningful way that pattern in the data starts making sense. Nevertheless, the descriptive analysis does not go beyond making conclusions. The conclusions are again based on the hypothesis researchers have formulated so far. Here are a few major types of descriptive analysis methods.

Measures of Frequency

• Count, Percent, Frequency
• It is used to denote home often a particular event occurs.
• Researchers use it when they want to showcase how often a response is given.

Measures of Central Tendency

• Mean, Median, Mode
• The method is widely used to demonstrate distribution by various points.
• Researchers use this method when they want to showcase the most commonly or averagely indicated response.

Measures of Dispersion or Variation

• Range, Variance, Standard deviation
• Here the field equals high/low points.
• Variance standard deviation = difference between the observed score and mean
• It is used to identify the spread of scores by stating intervals.
• Researchers use this method to showcase data spread out. It helps them identify the depth until which the data is spread out that it directly affects the mean.

Measures of Position

• Percentile ranks, Quartile ranks
• It relies on standardized scores helping researchers to identify the relationship between different scores.
• It is often used when researchers want to compare scores with the average count.

For quantitative research use of descriptive analysis often give absolute numbers, but the in-depth analysis is never sufficient to demonstrate the rationale behind those numbers. Nevertheless, it is necessary to think of the best method for research and data analysis suiting your survey questionnaire and what story researchers want to tell. For example, the mean is the best way to demonstrate the students’ average scores in schools. It is better to rely on the descriptive statistics when the researchers intend to keep the research or outcome limited to the provided  sample  without generalizing it. For example, when you want to compare average voting done in two different cities, differential statistics are enough.

Descriptive analysis is also called a ‘univariate analysis’ since it is commonly used to analyze a single variable.

Inferential statistics

Inferential statistics are used to make predictions about a larger population after research and data analysis of the representing population’s collected sample. For example, you can ask some odd 100 audiences at a movie theater if they like the movie they are watching. Researchers then use inferential statistics on the collected  sample  to reason that about 80-90% of people like the movie. 

Here are two significant areas of inferential statistics.

• Estimating parameters: It takes statistics from the sample research data and demonstrates something about the population parameter.
• Hypothesis test: I t’s about sampling research data to answer the survey research questions. For example, researchers might be interested to understand if the new shade of lipstick recently launched is good or not, or if the multivitamin capsules help children to perform better at games.

These are sophisticated analysis methods used to showcase the relationship between different variables instead of describing a single variable. It is often used when researchers want something beyond absolute numbers to understand the relationship between variables.

Here are some of the commonly used methods for data analysis in research.

• Correlation: When researchers are not conducting experimental research or quasi-experimental research wherein the researchers are interested to understand the relationship between two or more variables, they opt for correlational research methods.
• Cross-tabulation: Also called contingency tables,  cross-tabulation  is used to analyze the relationship between multiple variables.  Suppose provided data has age and gender categories presented in rows and columns. A two-dimensional cross-tabulation helps for seamless data analysis and research by showing the number of males and females in each age category.
• Regression analysis: For understanding the strong relationship between two variables, researchers do not look beyond the primary and commonly used regression analysis method, which is also a type of predictive analysis used. In this method, you have an essential factor called the dependent variable. You also have multiple independent variables in regression analysis. You undertake efforts to find out the impact of independent variables on the dependent variable. The values of both independent and dependent variables are assumed as being ascertained in an error-free random manner.
• Frequency tables: The statistical procedure is used for testing the degree to which two or more vary or differ in an experiment. A considerable degree of variation means research findings were significant. In many contexts, ANOVA testing and variance analysis are similar.
• Analysis of variance: The statistical procedure is used for testing the degree to which two or more vary or differ in an experiment. A considerable degree of variation means research findings were significant. In many contexts, ANOVA testing and variance analysis are similar.
• Researchers must have the necessary research skills to analyze and manipulation the data , Getting trained to demonstrate a high standard of research practice. Ideally, researchers must possess more than a basic understanding of the rationale of selecting one statistical method over the other to obtain better data insights.
• Usually, research and data analytics projects differ by scientific discipline; therefore, getting statistical advice at the beginning of analysis helps design a survey questionnaire, select data collection methods , and choose samples.

LEARN ABOUT: Best Data Collection Tools

• The primary aim of data research and analysis is to derive ultimate insights that are unbiased. Any mistake in or keeping a biased mind to collect data, selecting an analysis method, or choosing  audience  sample il to draw a biased inference.
• Irrelevant to the sophistication used in research data and analysis is enough to rectify the poorly defined objective outcome measurements. It does not matter if the design is at fault or intentions are not clear, but lack of clarity might mislead readers, so avoid the practice.
• The motive behind data analysis in research is to present accurate and reliable data. As far as possible, avoid statistical errors, and find a way to deal with everyday challenges like outliers, missing data, data altering, data mining , or developing graphical representation.

LEARN MORE: Descriptive Research vs Correlational Research The sheer amount of data generated daily is frightening. Especially when data analysis has taken center stage. in 2018. In last year, the total data supply amounted to 2.8 trillion gigabytes. Hence, it is clear that the enterprises willing to survive in the hypercompetitive world must possess an excellent capability to analyze complex research data, derive actionable insights, and adapt to the new market needs.

LEARN ABOUT: Average Order Value

QuestionPro is an online survey platform that empowers organizations in data analysis and research and provides them a medium to collect data by creating appealing surveys.

MORE LIKE THIS

Data Information vs Insight: Essential differences

May 14, 2024

Pricing Analytics Software: Optimize Your Pricing Strategy

May 13, 2024

Relationship Marketing: What It Is, Examples & Top 7 Benefits

May 8, 2024

The Best Email Survey Tool to Boost Your Feedback Game

May 7, 2024

Other categories

• Academic Research
• Artificial Intelligence
• Assessments
• Brand Awareness
• Case Studies
• Communities
• Consumer Insights
• Customer effort score
• Customer Engagement
• Customer Experience
• Customer Loyalty
• Customer Research
• Customer Satisfaction
• Employee Benefits
• Employee Engagement
• Employee Retention
• Friday Five
• General Data Protection Regulation
• Insights Hub
• Life@QuestionPro
• Market Research
• Mobile diaries
• Mobile Surveys
• New Features
• Online Communities
• Question Types
• Questionnaire
• QuestionPro Products
• Release Notes
• Research Tools and Apps
• Revenue at Risk
• Survey Templates
• Training Tips
• Uncategorized
• Video Learning Series
• What’s Coming Up
• Workforce Intelligence

Find what you need to study

Academic Paper: Discussion and Analysis

5 min read • march 10, 2023

Dylan Black

Introduction

After presenting your data and results to readers, you have one final step before you can finally wrap up your paper and write a conclusion: analyzing your data! This is the big part of your paper that finally takes all the stuff you've been talking about - your method, the data you collected, the information presented in your literature review - and uses it to make a point!

The major question to be answered in your analysis section is simply "we have all this data, but what does it mean?" What questions does this data answer? How does it relate to your research question ? Can this data be explained by, and is it consistent with, other papers? If not, why? These are the types of questions you'll be discussing in this section.

Source: GIPHY

Writing a Discussion and Analysis

Explain what your data means.

The primary point of a discussion section is to explain to your readers, through both statistical means and thorough explanation, what your results mean for your project. In doing so, you want to be succinct, clear, and specific about how your data backs up the claims you are making. These claims should be directly tied back to the overall focus of your paper.

What is this overall focus, you may ask? Your research question ! This discussion along with your conclusion forms the final analysis of your research - what answers did we find? Was our research successful? How do the results we found tie into and relate to the current consensus by the research community? Were our results expected or unexpected? Why or why not? These are all questions you may consider in writing your discussion section.

You showing off all of the cool findings of your research! Source: GIPHY

Why Did Your Results Happen?

After presenting your results in your results section, you may also want to explain why your results actually occurred. This is integral to gaining a full understanding of your results and the conclusions you can draw from them. For example, if data you found contradicts certain data points found in other studies, one of the most important aspects of your discussion of said data is going to be theorizing as to why this disparity took place.

Note that making broad, sweeping claims based on your data is not enough! Everything, and I mean just about everything you say in your discussions section must be backed up either by your own findings that you showed in your results section or past research that has been performed in your field.

For many situations, finding these answers is not easy, and a lot of thinking must be done as to why your results actually occurred the way they did. For some fields, specifically STEM-related fields, a discussion might dive into the theoretical foundations of your research, explaining interactions between parts of your study that led to your results. For others, like social sciences and humanities, results may be open to more interpretation.

However, "open to more interpretation" does not mean you can make claims willy nilly and claim "author's interpretation". In fact, such interpretation may be harder than STEM explanations! You will have to synthesize existing analysis on your topic and incorporate that in your analysis.

Liam Neeson explains the major question of your analysis. Source: GIPHY

Discussion vs. Summary & Repetition

Quite possibly the biggest mistake made within a discussion section is simply restating your data in a different format. The role of the discussion section is to explain your data and what it means for your project. Many students, thinking they're making discussion and analysis, simply regurgitate their numbers back in full sentences with a surface-level explanation.

Phrases like "this shows" and others similar, while good building blocks and great planning tools, often lead to a relatively weak discussion that isn't very nuanced and doesn't lead to much new understanding.

Instead, your goal will be to, through this section and your conclusion, establish a new understanding and in the end, close your gap! To do this effectively, you not only will have to present the numbers and results of your study, but you'll also have to describe how such data forms a new idea that has not been found in prior research.

This, in essence, is the heart of research - finding something new that hasn't been studied before! I don't know if it's just us, but that's pretty darn cool and something that you as the researcher should be incredibly proud of yourself for accomplishing.

Rubric Points

Before we close out this guide, let's take a quick peek at our best friend: the AP Research Rubric for the Discussion and Conclusion sections.

Source: CollegeBoard

Scores of One and Two: Nothing New, Your Standard Essay

Responses that earn a score of one or two on this section of the AP Research Academic Paper typically don't find much new and by this point may not have a fully developed method nor well-thought-out results. For the most part, these are more similar to essays you may have written in a prior English class or AP Seminar than a true Research paper. Instead of finding new ideas, they summarize already existing information about a topic.

Score of Three: New Understanding, Not Enough Support

A score of three is the first row that establishes a new understanding! This is a great step forward from a one or a two. However, what differentiates a three from a four or a five is the explanation and support of such a new understanding. A paper that earns a three lacks in building a line of reasoning and does not present enough evidence, both from their results section and from already published research.

Scores of Four and Five: New Understanding With A Line of Reasoning

We've made it to the best of the best! With scores of four and five, successful papers describe a new understanding with an effective line of reasoning, sufficient evidence, and an all-around great presentation of how their results signify filling a gap and answering a research question .

As far as the discussions section goes, the difference between a four and a five is more on the side of complexity and nuance. Where a four hits all the marks and does it well, a five exceeds this and writes a truly exceptional analysis. Another area where these two sections differ is in the limitations described, which we discuss in the Conclusion section guide.

You did it!!!! You have, for the most part, finished the brunt of your research paper and are over the hump! All that's left to do is tackle the conclusion, which tends to be for most the easiest section to write because all you do is summarize how your research question was answered and make some final points about how your research impacts your field. Finally, as always...

Key Terms to Review ( 1 )

Research Question

Stay Connected

© 2024 Fiveable Inc. All rights reserved.

AP® and SAT® are trademarks registered by the College Board, which is not affiliated with, and does not endorse this website.

How Do I Write the Discussion Chapter?

Reflecting on and Comparing Your Data, Recognising the Strengths and Limitations

• First Online: 19 October 2023

Cite this chapter

• Sue Reeves   ORCID: orcid.org/0000-0002-3017-0559 3 &
• Bartek Buczkowski   ORCID: orcid.org/0000-0002-4146-3664 4  

381 Accesses

The Discussion chapter brings an opportunity to write an academic argument that contains a detailed critical evaluation and analysis of your research findings. This chapter addresses the purpose and critical nature of the discussion, contains a guide to selecting key results to discuss, and details how best to structure the discussion with subsections and paragraphs. We also present a list of points to do and avoid when writing the discussion together with a Discussion chapter checklist.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

• Available as EPUB and PDF
• Read on any device
• Instant download
• Own it forever
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Braun V, Clarke V (2013) Successful qualitative research: a practical guide for beginners. SAGE Publications, London

Google Scholar  

McGregor SLT (2018) Understanding and evaluating research: a critical guide. SAGE Publications, Los Angeles, CA

Book   Google Scholar  

PLOS (2023) Author resources. How to write discussions and conclusions. Accessed Mar 3, 2023, from https://plos.org/resource/how-to-write-conclusions/ . Accessed 3 Mar 2023

Further Reading

Cottrell S (2017) Critical thinking skills: effective analysis, argument and reflection, 3rd edn. Palgrave, London

Download references

Author information

Authors and affiliations.

University of Roehampton, London, UK

Manchester Metropolitan University, Manchester, UK

Bartek Buczkowski

You can also search for this author in PubMed   Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Reeves, S., Buczkowski, B. (2023). How Do I Write the Discussion Chapter?. In: Mastering Your Dissertation. Springer, Cham. https://doi.org/10.1007/978-3-031-41911-9_9

Download citation

DOI : https://doi.org/10.1007/978-3-031-41911-9_9

Published : 19 October 2023

Publisher Name : Springer, Cham

Print ISBN : 978-3-031-41910-2

Online ISBN : 978-3-031-41911-9

eBook Packages : Biomedical and Life Sciences Biomedical and Life Sciences (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

We use cookies on this site to enhance your experience

By clicking any link on this page you are giving your consent for us to set cookies.

A link to reset your password has been sent to your email.

Back to login

We need additional information from you. Please complete your profile first before placing your order.

Thank you. payment completed., you will receive an email from us to confirm your registration, please click the link in the email to activate your account., there was error during payment, orcid profile found in public registry, download history, how to write the analysis and discussion chapters in qualitative (ssah) research.

• Charlesworth Author Services
• 11 November, 2021

While it is more common for Science, Technology, Engineering and Mathematics (STEM) researchers to write separate, distinct chapters for their data/ results and analysis/ discussion , the same sections can feel less clearly defined for a researcher in Social Sciences, Arts and Humanities (SSAH). This article will look specifically at some useful approaches to writing the analysis and discussion chapters in qualitative/SSAH research.

Note : Most of the differences in approaches to research, writing, analysis and discussion come down, ultimately, to differences in epistemology – how we approach, create and work with knowledge in our respective fields. However, this is a vast topic that deserves a separate discussion.

Look for emerging themes and patterns

The ‘results’ of qualitative research can sometimes be harder to pinpoint than in quantitative research. You’re not dealing with definitive numbers and results in the same way as, say, a scientist conducting experiments that produce measurable data. Instead, most qualitative researchers explore prominent, interesting themes and patterns emerging from their data – that could comprise interviews, textual material or participant observation, for example. 

You may find that your data presents a huge number of themes, issues and topics, all of which you might find equally significant and interesting. In fact, you might find yourself overwhelmed by the many directions that your research could take, depending on which themes you choose to study in further depth. You may even discover issues and patterns that you had not expected , that may necessitate having to change or expand the research focus you initially started off with.

It is crucial at this point not to panic. Instead, try to enjoy the many possibilities that your data is offering you. It can be useful to remind yourself at each stage of exactly what you are trying to find out through this research.

What exactly do you want to know? What knowledge do you want to generate and share within your field?

Then, spend some time reflecting upon each of the themes that seem most interesting and significant, and consider whether they are immediately relevant to your main, overarching research objectives and goals.

Suggestion: Don’t worry too much about structure and flow at the early stages of writing your discussion . It would be a more valuable use of your time to fully explore the themes and issues arising from your data first, while also reading widely alongside your writing (more on this below). As you work more intimately with the data and develop your ideas, the overarching narrative and connections between those ideas will begin to emerge. Trust that you’ll be able to draw those links and craft the structure organically as you write.

Let your data guide you

A key characteristic of qualitative research is that the researchers allow their data to ‘speak’ and guide their research and their writing. Instead of insisting too strongly upon the prominence of specific themes and issues and imposing their opinions and beliefs upon the data, a good qualitative researcher ‘listens’ to what the data has to tell them.

Again, you might find yourself having to address unexpected issues or your data may reveal things that seem completely contradictory to the ideas and theories you have worked with so far. Although this might seem worrying, discovering these unexpected new elements can actually make your research much richer and more interesting. 

Suggestion: Allow yourself to follow those leads and ask new questions as you work through your data. These new directions could help you to answer your research questions in more depth and with greater complexity; or they could even open up other avenues for further study, either in this or future research.

Work closely with the literature

As you analyse and discuss the prominent themes, arguments and findings arising from your data, it is very helpful to maintain a regular and consistent reading practice alongside your writing. Return to the literature that you’ve already been reading so far or begin to check out new texts, studies and theories that might be more appropriate for working with any new ideas and themes arising from your data.

Reading and incorporating relevant literature into your writing as you work through your analysis and discussion will help you to consistently contextualise your research within the larger body of knowledge. It will be easier to stay focused on what you are trying to say through your research if you can simultaneously show what has already been said on the subject and how your research and data supports, challenges or extends those debates. By drawing from existing literature , you are setting up a dialogue between your research and prior work, and highlighting what this research has to add to the conversation.

Suggestion : Although it might sometimes feel tedious to have to blend others’ writing in with yours, this is ultimately the best way to showcase the specialness of your own data, findings and research . Remember that it is more difficult to highlight the significance and relevance of your original work without first showing how that work fits into or responds to existing studies. 

In conclusion

The discussion chapters form the heart of your thesis and this is where your unique contribution comes to the forefront. This is where your data takes centre-stage and where you get to showcase your original arguments, perspectives and knowledge. To do this effectively needs you to explore the original themes and issues arising from and within the data, while simultaneously contextualising these findings within the larger, existing body of knowledge of your specialising field. By striking this balance, you prove the two most important qualities of excellent qualitative research : keen awareness of your field and a firm understanding of your place in it.

Charlesworth Author Services , a trusted brand supporting the world’s leading academic publishers, institutions and authors since 1928. 

To know more about our services, visit: Our Services

Visit our new Researcher Education Portal that offers articles and webinars covering all aspects of your research to publication journey! And sign up for our newsletter on the Portal to stay updated on all essential researcher knowledge and information!

Register now: Researcher Education Portal

Maximise your publication success with Charlesworth Author Services.

Share with your colleagues

Related articles.

How to write an Introduction to an academic article

Charlesworth Author Services 17/08/2020 00:00:00

The best way to write the Study Background

Charlesworth Author Services 25/10/2021 00:00:00

Conducting a Literature Review

Charlesworth Author Services 10/03/2021 00:00:00

Related webinars

Bitesize Webinar: How to write and structure your academic article for publication: Module 4: Prepare to write your academic paper

Charlesworth Author Services 04/03/2021 00:00:00

Bitesize Webinar: How to write and structure your academic article for publication: Module 5: Conduct a Literature Review

Bitesize Webinar: How to write and structure your academic article for publication: Module 6: Choose great titles and write strong abstracts

Charlesworth Author Services 05/03/2021 00:00:00

Bitesize Webinar: How to write and structure your academic article for publication: Module 7: Write a strong theoretical framework section

Literature review.

Important factors to consider as you Start to Plan your Literature Review

Charlesworth Author Services 06/10/2021 00:00:00

Difference between a Literature Review and a Critical Review

Charlesworth Author Services 08/10/2021 00:00:00

How to refer to other studies or literature in the different sections of a research paper

Charlesworth Author Services 07/10/2021 00:00:00

When you choose to publish with PLOS, your research makes an impact. Make your work accessible to all, without restrictions, and accelerate scientific discovery with options like preprints and published peer review that make your work more Open.

• PLOS Biology
• PLOS Climate
• PLOS Complex Systems
• PLOS Computational Biology
• PLOS Digital Health
• PLOS Genetics
• PLOS Global Public Health
• PLOS Medicine
• PLOS Mental Health
• PLOS Neglected Tropical Diseases
• PLOS Pathogens
• PLOS Sustainability and Transformation
• PLOS Collections
• How to Write Discussions and Conclusions

The discussion section contains the results and outcomes of a study. An effective discussion informs readers what can be learned from your experiment and provides context for the results.

What makes an effective discussion?

When you’re ready to write your discussion, you’ve already introduced the purpose of your study and provided an in-depth description of the methodology. The discussion informs readers about the larger implications of your study based on the results. Highlighting these implications while not overstating the findings can be challenging, especially when you’re submitting to a journal that selects articles based on novelty or potential impact. Regardless of what journal you are submitting to, the discussion section always serves the same purpose: concluding what your study results actually mean.

A successful discussion section puts your findings in context. It should include:

• the results of your research,
• a discussion of related research, and
• a comparison between your results and initial hypothesis.

Tip: Not all journals share the same naming conventions.

You can apply the advice in this article to the conclusion, results or discussion sections of your manuscript.

Our Early Career Researcher community tells us that the conclusion is often considered the most difficult aspect of a manuscript to write. To help, this guide provides questions to ask yourself, a basic structure to model your discussion off of and examples from published manuscripts. 

Questions to ask yourself:

• Was my hypothesis correct?
• If my hypothesis is partially correct or entirely different, what can be learned from the results? 
• How do the conclusions reshape or add onto the existing knowledge in the field? What does previous research say about the topic? 
• Why are the results important or relevant to your audience? Do they add further evidence to a scientific consensus or disprove prior studies? 
• How can future research build on these observations? What are the key experiments that must be done? 
• What is the “take-home” message you want your reader to leave with?

How to structure a discussion

Trying to fit a complete discussion into a single paragraph can add unnecessary stress to the writing process. If possible, you’ll want to give yourself two or three paragraphs to give the reader a comprehensive understanding of your study as a whole. Here’s one way to structure an effective discussion:

Writing Tips

While the above sections can help you brainstorm and structure your discussion, there are many common mistakes that writers revert to when having difficulties with their paper. Writing a discussion can be a delicate balance between summarizing your results, providing proper context for your research and avoiding introducing new information. Remember that your paper should be both confident and honest about the results! 

• Read the journal’s guidelines on the discussion and conclusion sections. If possible, learn about the guidelines before writing the discussion to ensure you’re writing to meet their expectations. 
• Begin with a clear statement of the principal findings. This will reinforce the main take-away for the reader and set up the rest of the discussion. 
• Explain why the outcomes of your study are important to the reader. Discuss the implications of your findings realistically based on previous literature, highlighting both the strengths and limitations of the research. 
• State whether the results prove or disprove your hypothesis. If your hypothesis was disproved, what might be the reasons? 
• Introduce new or expanded ways to think about the research question. Indicate what next steps can be taken to further pursue any unresolved questions. 
• If dealing with a contemporary or ongoing problem, such as climate change, discuss possible consequences if the problem is avoided. 
• Be concise. Adding unnecessary detail can distract from the main findings. 

Don’t

• Rewrite your abstract. Statements with “we investigated” or “we studied” generally do not belong in the discussion. 
• Include new arguments or evidence not previously discussed. Necessary information and evidence should be introduced in the main body of the paper. 
• Apologize. Even if your research contains significant limitations, don’t undermine your authority by including statements that doubt your methodology or execution. 
• Shy away from speaking on limitations or negative results. Including limitations and negative results will give readers a complete understanding of the presented research. Potential limitations include sources of potential bias, threats to internal or external validity, barriers to implementing an intervention and other issues inherent to the study design. 
• Overstate the importance of your findings. Making grand statements about how a study will fully resolve large questions can lead readers to doubt the success of the research. 

Snippets of Effective Discussions:

Consumer-based actions to reduce plastic pollution in rivers: A multi-criteria decision analysis approach

Identifying reliable indicators of fitness in polar bears

• How to Write a Great Title
• How to Write an Abstract
• How to Write Your Methods
• How to Report Statistics
• How to Edit Your Work

The contents of the Peer Review Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

The contents of the Writing Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

There’s a lot to consider when deciding where to submit your work. Learn how to choose a journal that will help your study reach its audience, while reflecting your values as a researcher…

Research Guide: Data analysis and reporting findings

• Postgraduate Online Training subject guide This link opens in a new window
• Open Educational Resources (OERs)
• Library support
• Research ideas
• You and your supervisor
• Researcher skills
• Research Data Management This link opens in a new window
• Literature review
• Plagiarism This link opens in a new window
• Research Methods
• Data analysis and reporting findings
• Statistical support
• Writing support
• Researcher visibility
• Conferences and Presentations
• Postgraduate Forums
• Soft skills development
• Emotional support
• The Commons Informer (blog)
• Research Tip Archives
• RC Newsletter Archives
• Evaluation Forms

Data analysis and findings

Data analysis is the most crucial part of any research. Data analysis summarizes collected data. It involves the interpretation of data gathered through the use of analytical and logical reasoning to determine patterns, relationships or trends. 

Data Analysis Checklist

Cleaning  data

* Did you capture and code your data in the right manner?

*Do you have all data or missing data?

* Do you have enough observations?

* Do you have any outliers? If yes, what is the remedy for outlier?

* Does your data have the potential to answer your questions?

Analyzing data

* Visualize your data, e.g. charts, tables, and graphs, to mention a few.

*  Identify patterns, correlations, and trends

* Test your hypotheses

* Let your data tell a story

Reports the results

* Communicate and interpret the results

* Conclude and recommend

* Your targeted audience must understand your results

* Use more datasets and samples

* Use accessible and understandable data analytical tool

* Do not delegate your data analysis

* Clean data to confirm that they are complete and free from errors

* Analyze cleaned data

* Understand your results

* Keep in mind who will be reading your results and present it in a way that they will understand it

* Share the results with the supervisor oftentimes

Past presentations

• PhD Writing Retreat - Analysing_Fieldwork_Data by Cori Wielenga A clear and concise presentation on the ‘now what’ and ‘so what’ of data collection and analysis - compiled and originally presented by Cori Wielenga.

Online Resources

• Qualitative analysis of interview data: A step-by-step guide
• Qualitative Data Analysis - Coding & Developing Themes

Recommended Quantitative Data Analysis books

Recommended Qualitative Data Analysis books

• << Previous: Data collection techniques
• Next: Statistical support >>
• Last Updated: Apr 22, 2024 11:02 AM
• URL: https://library.up.ac.za/c.php?g=485435

A Guide To The Methods, Benefits & Problems of The Interpretation of Data

Table of Contents

1) What Is Data Interpretation?

2) How To Interpret Data?

3) Why Data Interpretation Is Important?

4) Data Interpretation Skills

5) Data Analysis & Interpretation Problems

6) Data Interpretation Techniques & Methods

7) The Use of Dashboards For Data Interpretation

8) Business Data Interpretation Examples

Data analysis and interpretation have now taken center stage with the advent of the digital age… and the sheer amount of data can be frightening. In fact, a Digital Universe study found that the total data supply in 2012 was 2.8 trillion gigabytes! Based on that amount of data alone, it is clear the calling card of any successful enterprise in today’s global world will be the ability to analyze complex data, produce actionable insights, and adapt to new market needs… all at the speed of thought.

Business dashboards are the digital age tools for big data. Capable of displaying key performance indicators (KPIs) for both quantitative and qualitative data analyses, they are ideal for making the fast-paced and data-driven market decisions that push today’s industry leaders to sustainable success. Through the art of streamlined visual communication, data dashboards permit businesses to engage in real-time and informed decision-making and are key instruments in data interpretation. First of all, let’s find a definition to understand what lies behind this practice.

What Is Data Interpretation?

Data interpretation refers to the process of using diverse analytical methods to review data and arrive at relevant conclusions. The interpretation of data helps researchers to categorize, manipulate, and summarize the information in order to answer critical questions.

The importance of data interpretation is evident, and this is why it needs to be done properly. Data is very likely to arrive from multiple sources and has a tendency to enter the analysis process with haphazard ordering. Data analysis tends to be extremely subjective. That is to say, the nature and goal of interpretation will vary from business to business, likely correlating to the type of data being analyzed. While there are several types of processes that are implemented based on the nature of individual data, the two broadest and most common categories are “quantitative and qualitative analysis.”

Yet, before any serious data interpretation inquiry can begin, it should be understood that visual presentations of data findings are irrelevant unless a sound decision is made regarding measurement scales. Before any serious data analysis can begin, the measurement scale must be decided for the data as this will have a long-term impact on data interpretation ROI. The varying scales include:

• Nominal Scale: non-numeric categories that cannot be ranked or compared quantitatively. Variables are exclusive and exhaustive.
• Ordinal Scale: exclusive categories that are exclusive and exhaustive but with a logical order. Quality ratings and agreement ratings are examples of ordinal scales (i.e., good, very good, fair, etc., OR agree, strongly agree, disagree, etc.).
• Interval: a measurement scale where data is grouped into categories with orderly and equal distances between the categories. There is always an arbitrary zero point.
• Ratio: contains features of all three.

For a more in-depth review of scales of measurement, read our article on data analysis questions . Once measurement scales have been selected, it is time to select which of the two broad interpretation processes will best suit your data needs. Let’s take a closer look at those specific methods and possible data interpretation problems.

How To Interpret Data? Top Methods & Techniques

When interpreting data, an analyst must try to discern the differences between correlation, causation, and coincidences, as well as many other biases – but he also has to consider all the factors involved that may have led to a result. There are various data interpretation types and methods one can use to achieve this.

The interpretation of data is designed to help people make sense of numerical data that has been collected, analyzed, and presented. Having a baseline method for interpreting data will provide your analyst teams with a structure and consistent foundation. Indeed, if several departments have different approaches to interpreting the same data while sharing the same goals, some mismatched objectives can result. Disparate methods will lead to duplicated efforts, inconsistent solutions, wasted energy, and inevitably – time and money. In this part, we will look at the two main methods of interpretation of data: qualitative and quantitative analysis.

Qualitative Data Interpretation

Qualitative data analysis can be summed up in one word – categorical. With this type of analysis, data is not described through numerical values or patterns but through the use of descriptive context (i.e., text). Typically, narrative data is gathered by employing a wide variety of person-to-person techniques. These techniques include:

• Observations: detailing behavioral patterns that occur within an observation group. These patterns could be the amount of time spent in an activity, the type of activity, and the method of communication employed.
• Focus groups: Group people and ask them relevant questions to generate a collaborative discussion about a research topic.
• Secondary Research: much like how patterns of behavior can be observed, various types of documentation resources can be coded and divided based on the type of material they contain.
• Interviews: one of the best collection methods for narrative data. Inquiry responses can be grouped by theme, topic, or category. The interview approach allows for highly focused data segmentation.

A key difference between qualitative and quantitative analysis is clearly noticeable in the interpretation stage. The first one is widely open to interpretation and must be “coded” so as to facilitate the grouping and labeling of data into identifiable themes. As person-to-person data collection techniques can often result in disputes pertaining to proper analysis, qualitative data analysis is often summarized through three basic principles: notice things, collect things, and think about things.

After qualitative data has been collected through transcripts, questionnaires, audio and video recordings, or the researcher’s notes, it is time to interpret it. For that purpose, there are some common methods used by researchers and analysts.

• Content analysis : As its name suggests, this is a research method used to identify frequencies and recurring words, subjects, and concepts in image, video, or audio content. It transforms qualitative information into quantitative data to help discover trends and conclusions that will later support important research or business decisions. This method is often used by marketers to understand brand sentiment from the mouths of customers themselves. Through that, they can extract valuable information to improve their products and services. It is recommended to use content analytics tools for this method as manually performing it is very time-consuming and can lead to human error or subjectivity issues. Having a clear goal in mind before diving into it is another great practice for avoiding getting lost in the fog.  
• Thematic analysis: This method focuses on analyzing qualitative data, such as interview transcripts, survey questions, and others, to identify common patterns and separate the data into different groups according to found similarities or themes. For example, imagine you want to analyze what customers think about your restaurant. For this purpose, you do a thematic analysis on 1000 reviews and find common themes such as “fresh food”, “cold food”, “small portions”, “friendly staff”, etc. With those recurring themes in hand, you can extract conclusions about what could be improved or enhanced based on your customer’s experiences. Since this technique is more exploratory, be open to changing your research questions or goals as you go. 
• Narrative analysis: A bit more specific and complicated than the two previous methods, it is used to analyze stories and discover their meaning. These stories can be extracted from testimonials, case studies, and interviews, as these formats give people more space to tell their experiences. Given that collecting this kind of data is harder and more time-consuming, sample sizes for narrative analysis are usually smaller, which makes it harder to reproduce its findings. However, it is still a valuable technique for understanding customers' preferences and mindsets.  
• Discourse analysis : This method is used to draw the meaning of any type of visual, written, or symbolic language in relation to a social, political, cultural, or historical context. It is used to understand how context can affect how language is carried out and understood. For example, if you are doing research on power dynamics, using discourse analysis to analyze a conversation between a janitor and a CEO and draw conclusions about their responses based on the context and your research questions is a great use case for this technique. That said, like all methods in this section, discourse analytics is time-consuming as the data needs to be analyzed until no new insights emerge.  
• Grounded theory analysis : The grounded theory approach aims to create or discover a new theory by carefully testing and evaluating the data available. Unlike all other qualitative approaches on this list, grounded theory helps extract conclusions and hypotheses from the data instead of going into the analysis with a defined hypothesis. This method is very popular amongst researchers, analysts, and marketers as the results are completely data-backed, providing a factual explanation of any scenario. It is often used when researching a completely new topic or with little knowledge as this space to start from the ground up. 

Quantitative Data Interpretation

If quantitative data interpretation could be summed up in one word (and it really can’t), that word would be “numerical.” There are few certainties when it comes to data analysis, but you can be sure that if the research you are engaging in has no numbers involved, it is not quantitative research, as this analysis refers to a set of processes by which numerical data is analyzed. More often than not, it involves the use of statistical modeling such as standard deviation, mean, and median. Let’s quickly review the most common statistical terms:

• Mean: A mean represents a numerical average for a set of responses. When dealing with a data set (or multiple data sets), a mean will represent the central value of a specific set of numbers. It is the sum of the values divided by the number of values within the data set. Other terms that can be used to describe the concept are arithmetic mean, average, and mathematical expectation.
• Standard deviation: This is another statistical term commonly used in quantitative analysis. Standard deviation reveals the distribution of the responses around the mean. It describes the degree of consistency within the responses; together with the mean, it provides insight into data sets.
• Frequency distribution: This is a measurement gauging the rate of a response appearance within a data set. When using a survey, for example, frequency distribution, it can determine the number of times a specific ordinal scale response appears (i.e., agree, strongly agree, disagree, etc.). Frequency distribution is extremely keen in determining the degree of consensus among data points.

Typically, quantitative data is measured by visually presenting correlation tests between two or more variables of significance. Different processes can be used together or separately, and comparisons can be made to ultimately arrive at a conclusion. Other signature interpretation processes of quantitative data include:

• Regression analysis: Essentially, it uses historical data to understand the relationship between a dependent variable and one or more independent variables. Knowing which variables are related and how they developed in the past allows you to anticipate possible outcomes and make better decisions going forward. For example, if you want to predict your sales for next month, you can use regression to understand what factors will affect them, such as products on sale and the launch of a new campaign, among many others. 
• Cohort analysis: This method identifies groups of users who share common characteristics during a particular time period. In a business scenario, cohort analysis is commonly used to understand customer behaviors. For example, a cohort could be all users who have signed up for a free trial on a given day. An analysis would be carried out to see how these users behave, what actions they carry out, and how their behavior differs from other user groups.
• Predictive analysis: As its name suggests, the predictive method aims to predict future developments by analyzing historical and current data. Powered by technologies such as artificial intelligence and machine learning, predictive analytics practices enable businesses to identify patterns or potential issues and plan informed strategies in advance.
• Prescriptive analysis: Also powered by predictions, the prescriptive method uses techniques such as graph analysis, complex event processing, and neural networks, among others, to try to unravel the effect that future decisions will have in order to adjust them before they are actually made. This helps businesses to develop responsive, practical business strategies.
• Conjoint analysis: Typically applied to survey analysis, the conjoint approach is used to analyze how individuals value different attributes of a product or service. This helps researchers and businesses to define pricing, product features, packaging, and many other attributes. A common use is menu-based conjoint analysis, in which individuals are given a “menu” of options from which they can build their ideal concept or product. Through this, analysts can understand which attributes they would pick above others and drive conclusions.
• Cluster analysis: Last but not least, the cluster is a method used to group objects into categories. Since there is no target variable when using cluster analysis, it is a useful method to find hidden trends and patterns in the data. In a business context, clustering is used for audience segmentation to create targeted experiences. In market research, it is often used to identify age groups, geographical information, and earnings, among others.

Now that we have seen how to interpret data, let's move on and ask ourselves some questions: What are some of the benefits of data interpretation? Why do all industries engage in data research and analysis? These are basic questions, but they often don’t receive adequate attention.

Your Chance: Want to test a powerful data analysis software? Use our 14-days free trial & start extracting insights from your data!

Why Data Interpretation Is Important

The purpose of collection and interpretation is to acquire useful and usable information and to make the most informed decisions possible. From businesses to newlyweds researching their first home, data collection and interpretation provide limitless benefits for a wide range of institutions and individuals.

Data analysis and interpretation, regardless of the method and qualitative/quantitative status, may include the following characteristics:

• Data identification and explanation
• Comparing and contrasting data
• Identification of data outliers
• Future predictions

Data analysis and interpretation, in the end, help improve processes and identify problems. It is difficult to grow and make dependable improvements without, at the very least, minimal data collection and interpretation. What is the keyword? Dependable. Vague ideas regarding performance enhancement exist within all institutions and industries. Yet, without proper research and analysis, an idea is likely to remain in a stagnant state forever (i.e., minimal growth). So… what are a few of the business benefits of digital age data analysis and interpretation? Let’s take a look!

1) Informed decision-making: A decision is only as good as the knowledge that formed it. Informed data decision-making can potentially set industry leaders apart from the rest of the market pack. Studies have shown that companies in the top third of their industries are, on average, 5% more productive and 6% more profitable when implementing informed data decision-making processes. Most decisive actions will arise only after a problem has been identified or a goal defined. Data analysis should include identification, thesis development, and data collection, followed by data communication.

If institutions only follow that simple order, one that we should all be familiar with from grade school science fairs, then they will be able to solve issues as they emerge in real-time. Informed decision-making has a tendency to be cyclical. This means there is really no end, and eventually, new questions and conditions arise within the process that need to be studied further. The monitoring of data results will inevitably return the process to the start with new data and sights.

2) Anticipating needs with trends identification: data insights provide knowledge, and knowledge is power. The insights obtained from market and consumer data analyses have the ability to set trends for peers within similar market segments. A perfect example of how data analytics can impact trend prediction is evidenced in the music identification application Shazam . The application allows users to upload an audio clip of a song they like but can’t seem to identify. Users make 15 million song identifications a day. With this data, Shazam has been instrumental in predicting future popular artists.

When industry trends are identified, they can then serve a greater industry purpose. For example, the insights from Shazam’s monitoring benefits not only Shazam in understanding how to meet consumer needs but also grant music executives and record label companies an insight into the pop-culture scene of the day. Data gathering and interpretation processes can allow for industry-wide climate prediction and result in greater revenue streams across the market. For this reason, all institutions should follow the basic data cycle of collection, interpretation, decision-making, and monitoring.

3) Cost efficiency: Proper implementation of analytics processes can provide businesses with profound cost advantages within their industries. A recent data study performed by Deloitte vividly demonstrates this in finding that data analysis ROI is driven by efficient cost reductions. Often, this benefit is overlooked because making money is typically viewed as “sexier” than saving money. Yet, sound data analyses have the ability to alert management to cost-reduction opportunities without any significant exertion of effort on the part of human capital.

A great example of the potential for cost efficiency through data analysis is Intel. Prior to 2012, Intel would conduct over 19,000 manufacturing function tests on their chips before they could be deemed acceptable for release. To cut costs and reduce test time, Intel implemented predictive data analyses. By using historical and current data, Intel now avoids testing each chip 19,000 times by focusing on specific and individual chip tests. After its implementation in 2012, Intel saved over $3 million in manufacturing costs. Cost reduction may not be as “sexy” as data profit, but as Intel proves, it is a benefit of data analysis that should not be neglected.

4) Clear foresight: companies that collect and analyze their data gain better knowledge about themselves, their processes, and their performance. They can identify performance challenges when they arise and take action to overcome them. Data interpretation through visual representations lets them process their findings faster and make better-informed decisions on the company's future.

Key Data Interpretation Skills You Should Have

Just like any other process, data interpretation and analysis require researchers or analysts to have some key skills to be able to perform successfully. It is not enough just to apply some methods and tools to the data; the person who is managing it needs to be objective and have a data-driven mind, among other skills. 

It is a common misconception to think that the required skills are mostly number-related. While data interpretation is heavily analytically driven, it also requires communication and narrative skills, as the results of the analysis need to be presented in a way that is easy to understand for all types of audiences. 

Luckily, with the rise of self-service tools and AI-driven technologies, data interpretation is no longer segregated for analysts only. However, the topic still remains a big challenge for businesses that make big investments in data and tools to support it, as the interpretation skills required are still lacking. It is worthless to put massive amounts of money into extracting information if you are not going to be able to interpret what that information is telling you. For that reason, below we list the top 5 data interpretation skills your employees or researchers should have to extract the maximum potential from the data. 

• Data Literacy: The first and most important skill to have is data literacy. This means having the ability to understand, work, and communicate with data. It involves knowing the types of data sources, methods, and ethical implications of using them. In research, this skill is often a given. However, in a business context, there might be many employees who are not comfortable with data. The issue is the interpretation of data can not be solely responsible for the data team, as it is not sustainable in the long run. Experts advise business leaders to carefully assess the literacy level across their workforce and implement training instances to ensure everyone can interpret their data. 
• Data Tools: The data interpretation and analysis process involves using various tools to collect, clean, store, and analyze the data. The complexity of the tools varies depending on the type of data and the analysis goals. Going from simple ones like Excel to more complex ones like databases, such as SQL, or programming languages, such as R or Python. It also involves visual analytics tools to bring the data to life through the use of graphs and charts. Managing these tools is a fundamental skill as they make the process faster and more efficient. As mentioned before, most modern solutions are now self-service, enabling less technical users to use them without problem.
• Critical Thinking: Another very important skill is to have critical thinking. Data hides a range of conclusions, trends, and patterns that must be discovered. It is not just about comparing numbers; it is about putting a story together based on multiple factors that will lead to a conclusion. Therefore, having the ability to look further from what is right in front of you is an invaluable skill for data interpretation. 
• Data Ethics: In the information age, being aware of the legal and ethical responsibilities that come with the use of data is of utmost importance. In short, data ethics involves respecting the privacy and confidentiality of data subjects, as well as ensuring accuracy and transparency for data usage. It requires the analyzer or researcher to be completely objective with its interpretation to avoid any biases or discrimination. Many countries have already implemented regulations regarding the use of data, including the GDPR or the ACM Code Of Ethics. Awareness of these regulations and responsibilities is a fundamental skill that anyone working in data interpretation should have. 
• Domain Knowledge: Another skill that is considered important when interpreting data is to have domain knowledge. As mentioned before, data hides valuable insights that need to be uncovered. To do so, the analyst needs to know about the industry or domain from which the information is coming and use that knowledge to explore it and put it into a broader context. This is especially valuable in a business context, where most departments are now analyzing data independently with the help of a live dashboard instead of relying on the IT department, which can often overlook some aspects due to a lack of expertise in the topic. 

Common Data Analysis And Interpretation Problems

The oft-repeated mantra of those who fear data advancements in the digital age is “big data equals big trouble.” While that statement is not accurate, it is safe to say that certain data interpretation problems or “pitfalls” exist and can occur when analyzing data, especially at the speed of thought. Let’s identify some of the most common data misinterpretation risks and shed some light on how they can be avoided:

1) Correlation mistaken for causation: our first misinterpretation of data refers to the tendency of data analysts to mix the cause of a phenomenon with correlation. It is the assumption that because two actions occurred together, one caused the other. This is inaccurate, as actions can occur together, absent a cause-and-effect relationship.

• Digital age example: assuming that increased revenue results from increased social media followers… there might be a definitive correlation between the two, especially with today’s multi-channel purchasing experiences. But that does not mean an increase in followers is the direct cause of increased revenue. There could be both a common cause and an indirect causality.
• Remedy: attempt to eliminate the variable you believe to be causing the phenomenon.

2) Confirmation bias: our second problem is data interpretation bias. It occurs when you have a theory or hypothesis in mind but are intent on only discovering data patterns that support it while rejecting those that do not.

• Digital age example: your boss asks you to analyze the success of a recent multi-platform social media marketing campaign. While analyzing the potential data variables from the campaign (one that you ran and believe performed well), you see that the share rate for Facebook posts was great, while the share rate for Twitter Tweets was not. Using only Facebook posts to prove your hypothesis that the campaign was successful would be a perfect manifestation of confirmation bias.
• Remedy: as this pitfall is often based on subjective desires, one remedy would be to analyze data with a team of objective individuals. If this is not possible, another solution is to resist the urge to make a conclusion before data exploration has been completed. Remember to always try to disprove a hypothesis, not prove it.

3) Irrelevant data: the third data misinterpretation pitfall is especially important in the digital age. As large data is no longer centrally stored and as it continues to be analyzed at the speed of thought, it is inevitable that analysts will focus on data that is irrelevant to the problem they are trying to correct.

• Digital age example: in attempting to gauge the success of an email lead generation campaign, you notice that the number of homepage views directly resulting from the campaign increased, but the number of monthly newsletter subscribers did not. Based on the number of homepage views, you decide the campaign was a success when really it generated zero leads.
• Remedy: proactively and clearly frame any data analysis variables and KPIs prior to engaging in a data review. If the metric you use to measure the success of a lead generation campaign is newsletter subscribers, there is no need to review the number of homepage visits. Be sure to focus on the data variable that answers your question or solves your problem and not on irrelevant data.

4) Truncating an Axes: When creating a graph to start interpreting the results of your analysis, it is important to keep the axes truthful and avoid generating misleading visualizations. Starting the axes in a value that doesn’t portray the actual truth about the data can lead to false conclusions. 

• Digital age example: In the image below, we can see a graph from Fox News in which the Y-axes start at 34%, making it seem that the difference between 35% and 39.6% is way higher than it actually is. This could lead to a misinterpretation of the tax rate changes. 

* Source : www.venngage.com *

• Remedy: Be careful with how your data is visualized. Be respectful and realistic with axes to avoid misinterpretation of your data. See below how the Fox News chart looks when using the correct axis values. This chart was created with datapine's modern online data visualization tool.

5) (Small) sample size: Another common problem is using a small sample size. Logically, the bigger the sample size, the more accurate and reliable the results. However, this also depends on the size of the effect of the study. For example, the sample size in a survey about the quality of education will not be the same as for one about people doing outdoor sports in a specific area. 

• Digital age example: Imagine you ask 30 people a question, and 29 answer “yes,” resulting in 95% of the total. Now imagine you ask the same question to 1000, and 950 of them answer “yes,” which is again 95%. While these percentages might look the same, they certainly do not mean the same thing, as a 30-person sample size is not a significant number to establish a truthful conclusion. 
• Remedy: Researchers say that in order to determine the correct sample size to get truthful and meaningful results, it is necessary to define a margin of error that will represent the maximum amount they want the results to deviate from the statistical mean. Paired with this, they need to define a confidence level that should be between 90 and 99%. With these two values in hand, researchers can calculate an accurate sample size for their studies.

6) Reliability, subjectivity, and generalizability : When performing qualitative analysis, researchers must consider practical and theoretical limitations when interpreting the data. In some cases, this type of research can be considered unreliable because of uncontrolled factors that might or might not affect the results. This is paired with the fact that the researcher has a primary role in the interpretation process, meaning he or she decides what is relevant and what is not, and as we know, interpretations can be very subjective.

Generalizability is also an issue that researchers face when dealing with qualitative analysis. As mentioned in the point about having a small sample size, it is difficult to draw conclusions that are 100% representative because the results might be biased or unrepresentative of a wider population. 

While these factors are mostly present in qualitative research, they can also affect the quantitative analysis. For example, when choosing which KPIs to portray and how to portray them, analysts can also be biased and represent them in a way that benefits their analysis.

• Digital age example: Biased questions in a survey are a great example of reliability and subjectivity issues. Imagine you are sending a survey to your clients to see how satisfied they are with your customer service with this question: “How amazing was your experience with our customer service team?”. Here, we can see that this question clearly influences the response of the individual by putting the word “amazing” on it. 
• Remedy: A solution to avoid these issues is to keep your research honest and neutral. Keep the wording of the questions as objective as possible. For example: “On a scale of 1-10, how satisfied were you with our customer service team?”. This does not lead the respondent to any specific answer, meaning the results of your survey will be reliable. 

Data Interpretation Best Practices & Tips

Data analysis and interpretation are critical to developing sound conclusions and making better-informed decisions. As we have seen with this article, there is an art and science to the interpretation of data. To help you with this purpose, we will list a few relevant techniques, methods, and tricks you can implement for a successful data management process. 

As mentioned at the beginning of this post, the first step to interpreting data in a successful way is to identify the type of analysis you will perform and apply the methods respectively. Clearly differentiate between qualitative (observe, document, and interview notice, collect and think about things) and quantitative analysis (you lead research with a lot of numerical data to be analyzed through various statistical methods). 

1) Ask the right data interpretation questions

The first data interpretation technique is to define a clear baseline for your work. This can be done by answering some critical questions that will serve as a useful guideline to start. Some of them include: what are the goals and objectives of my analysis? What type of data interpretation method will I use? Who will use this data in the future? And most importantly, what general question am I trying to answer?

Once all this information has been defined, you will be ready for the next step: collecting your data. 

2) Collect and assimilate your data

Now that a clear baseline has been established, it is time to collect the information you will use. Always remember that your methods for data collection will vary depending on what type of analysis method you use, which can be qualitative or quantitative. Based on that, relying on professional online data analysis tools to facilitate the process is a great practice in this regard, as manually collecting and assessing raw data is not only very time-consuming and expensive but is also at risk of errors and subjectivity. 

Once your data is collected, you need to carefully assess it to understand if the quality is appropriate to be used during a study. This means, is the sample size big enough? Were the procedures used to collect the data implemented correctly? Is the date range from the data correct? If coming from an external source, is it a trusted and objective one? 

With all the needed information in hand, you are ready to start the interpretation process, but first, you need to visualize your data. 

3) Use the right data visualization type 

Data visualizations such as business graphs , charts, and tables are fundamental to successfully interpreting data. This is because data visualization via interactive charts and graphs makes the information more understandable and accessible. As you might be aware, there are different types of visualizations you can use, but not all of them are suitable for any analysis purpose. Using the wrong graph can lead to misinterpretation of your data, so it’s very important to carefully pick the right visual for it. Let’s look at some use cases of common data visualizations. 

• Bar chart: One of the most used chart types, the bar chart uses rectangular bars to show the relationship between 2 or more variables. There are different types of bar charts for different interpretations, including the horizontal bar chart, column bar chart, and stacked bar chart. 
• Line chart: Most commonly used to show trends, acceleration or decelerations, and volatility, the line chart aims to show how data changes over a period of time, for example, sales over a year. A few tips to keep this chart ready for interpretation are not using many variables that can overcrowd the graph and keeping your axis scale close to the highest data point to avoid making the information hard to read. 
• Pie chart: Although it doesn’t do a lot in terms of analysis due to its uncomplex nature, pie charts are widely used to show the proportional composition of a variable. Visually speaking, showing a percentage in a bar chart is way more complicated than showing it in a pie chart. However, this also depends on the number of variables you are comparing. If your pie chart needs to be divided into 10 portions, then it is better to use a bar chart instead. 
• Tables: While they are not a specific type of chart, tables are widely used when interpreting data. Tables are especially useful when you want to portray data in its raw format. They give you the freedom to easily look up or compare individual values while also displaying grand totals. 

With the use of data visualizations becoming more and more critical for businesses’ analytical success, many tools have emerged to help users visualize their data in a cohesive and interactive way. One of the most popular ones is the use of BI dashboards . These visual tools provide a centralized view of various graphs and charts that paint a bigger picture of a topic. We will discuss the power of dashboards for an efficient data interpretation practice in the next portion of this post. If you want to learn more about different types of graphs and charts , take a look at our complete guide on the topic. 

4) Start interpreting 

After the tedious preparation part, you can start extracting conclusions from your data. As mentioned many times throughout the post, the way you decide to interpret the data will solely depend on the methods you initially decided to use. If you had initial research questions or hypotheses, then you should look for ways to prove their validity. If you are going into the data with no defined hypothesis, then start looking for relationships and patterns that will allow you to extract valuable conclusions from the information. 

During the process of interpretation, stay curious and creative, dig into the data, and determine if there are any other critical questions that should be asked. If any new questions arise, you need to assess if you have the necessary information to answer them. Being able to identify if you need to dedicate more time and resources to the research is a very important step. No matter if you are studying customer behaviors or a new cancer treatment, the findings from your analysis may dictate important decisions in the future. Therefore, taking the time to really assess the information is key. For that purpose, data interpretation software proves to be very useful.

5) Keep your interpretation objective

As mentioned above, objectivity is one of the most important data interpretation skills but also one of the hardest. Being the person closest to the investigation, it is easy to become subjective when looking for answers in the data. A good way to stay objective is to show the information related to the study to other people, for example, research partners or even the people who will use your findings once they are done. This can help avoid confirmation bias and any reliability issues with your interpretation. 

Remember, using a visualization tool such as a modern dashboard will make the interpretation process way easier and more efficient as the data can be navigated and manipulated in an easy and organized way. And not just that, using a dashboard tool to present your findings to a specific audience will make the information easier to understand and the presentation way more engaging thanks to the visual nature of these tools. 

6) Mark your findings and draw conclusions

Findings are the observations you extracted from your data. They are the facts that will help you drive deeper conclusions about your research. For example, findings can be trends and patterns you found during your interpretation process. To put your findings into perspective, you can compare them with other resources that use similar methods and use them as benchmarks.

Reflect on your own thinking and reasoning and be aware of the many pitfalls data analysis and interpretation carry—correlation versus causation, subjective bias, false information, inaccurate data, etc. Once you are comfortable with interpreting the data, you will be ready to develop conclusions, see if your initial questions were answered, and suggest recommendations based on them.

Interpretation of Data: The Use of Dashboards Bridging The Gap

As we have seen, quantitative and qualitative methods are distinct types of data interpretation and analysis. Both offer a varying degree of return on investment (ROI) regarding data investigation, testing, and decision-making. But how do you mix the two and prevent a data disconnect? The answer is professional data dashboards. 

For a few years now, dashboards have become invaluable tools to visualize and interpret data. These tools offer a centralized and interactive view of data and provide the perfect environment for exploration and extracting valuable conclusions. They bridge the quantitative and qualitative information gap by unifying all the data in one place with the help of stunning visuals. 

Not only that, but these powerful tools offer a large list of benefits, and we will discuss some of them below. 

1) Connecting and blending data. With today’s pace of innovation, it is no longer feasible (nor desirable) to have bulk data centrally located. As businesses continue to globalize and borders continue to dissolve, it will become increasingly important for businesses to possess the capability to run diverse data analyses absent the limitations of location. Data dashboards decentralize data without compromising on the necessary speed of thought while blending both quantitative and qualitative data. Whether you want to measure customer trends or organizational performance, you now have the capability to do both without the need for a singular selection.

2) Mobile Data. Related to the notion of “connected and blended data” is that of mobile data. In today’s digital world, employees are spending less time at their desks and simultaneously increasing production. This is made possible because mobile solutions for analytical tools are no longer standalone. Today, mobile analysis applications seamlessly integrate with everyday business tools. In turn, both quantitative and qualitative data are now available on-demand where they’re needed, when they’re needed, and how they’re needed via interactive online dashboards .

3) Visualization. Data dashboards merge the data gap between qualitative and quantitative data interpretation methods through the science of visualization. Dashboard solutions come “out of the box” and are well-equipped to create easy-to-understand data demonstrations. Modern online data visualization tools provide a variety of color and filter patterns, encourage user interaction, and are engineered to help enhance future trend predictability. All of these visual characteristics make for an easy transition among data methods – you only need to find the right types of data visualization to tell your data story the best way possible.

4) Collaboration. Whether in a business environment or a research project, collaboration is key in data interpretation and analysis. Dashboards are online tools that can be easily shared through a password-protected URL or automated email. Through them, users can collaborate and communicate through the data in an efficient way. Eliminating the need for infinite files with lost updates. Tools such as datapine offer real-time updates, meaning your dashboards will update on their own as soon as new information is available.  

Examples Of Data Interpretation In Business

To give you an idea of how a dashboard can fulfill the need to bridge quantitative and qualitative analysis and help in understanding how to interpret data in research thanks to visualization, below, we will discuss three valuable examples to put their value into perspective.

1. Customer Satisfaction Dashboard 

This market research dashboard brings together both qualitative and quantitative data that are knowledgeably analyzed and visualized in a meaningful way that everyone can understand, thus empowering any viewer to interpret it. Let’s explore it below. 

**click to enlarge**

The value of this template lies in its highly visual nature. As mentioned earlier, visuals make the interpretation process way easier and more efficient. Having critical pieces of data represented with colorful and interactive icons and graphs makes it possible to uncover insights at a glance. For example, the colors green, yellow, and red on the charts for the NPS and the customer effort score allow us to conclude that most respondents are satisfied with this brand with a short glance. A further dive into the line chart below can help us dive deeper into this conclusion, as we can see both metrics developed positively in the past 6 months. 

The bottom part of the template provides visually stunning representations of different satisfaction scores for quality, pricing, design, and service. By looking at these, we can conclude that, overall, customers are satisfied with this company in most areas. 

2. Brand Analysis Dashboard

Next, in our list of data interpretation examples, we have a template that shows the answers to a survey on awareness for Brand D. The sample size is listed on top to get a perspective of the data, which is represented using interactive charts and graphs. 

When interpreting information, context is key to understanding it correctly. For that reason, the dashboard starts by offering insights into the demographics of the surveyed audience. In general, we can see ages and gender are diverse. Therefore, we can conclude these brands are not targeting customers from a specified demographic, an important aspect to put the surveyed answers into perspective. 

Looking at the awareness portion, we can see that brand B is the most popular one, with brand D coming second on both questions. This means brand D is not doing wrong, but there is still room for improvement compared to brand B. To see where brand D could improve, the researcher could go into the bottom part of the dashboard and consult the answers for branding themes and celebrity analysis. These are important as they give clear insight into what people and messages the audience associates with brand D. This is an opportunity to exploit these topics in different ways and achieve growth and success. 

3. Product Innovation Dashboard 

Our third and last dashboard example shows the answers to a survey on product innovation for a technology company. Just like the previous templates, the interactive and visual nature of the dashboard makes it the perfect tool to interpret data efficiently and effectively. 

Starting from right to left, we first get a list of the top 5 products by purchase intention. This information lets us understand if the product being evaluated resembles what the audience already intends to purchase. It is a great starting point to see how customers would respond to the new product. This information can be complemented with other key metrics displayed in the dashboard. For example, the usage and purchase intention track how the market would receive the product and if they would purchase it, respectively. Interpreting these values as positive or negative will depend on the company and its expectations regarding the survey. 

Complementing these metrics, we have the willingness to pay. Arguably, one of the most important metrics to define pricing strategies. Here, we can see that most respondents think the suggested price is a good value for money. Therefore, we can interpret that the product would sell for that price. 

To see more data analysis and interpretation examples for different industries and functions, visit our library of business dashboards .

To Conclude…

As we reach the end of this insightful post about data interpretation and analysis, we hope you have a clear understanding of the topic. We've covered the definition and given some examples and methods to perform a successful interpretation process.

The importance of data interpretation is undeniable. Dashboards not only bridge the information gap between traditional data interpretation methods and technology, but they can help remedy and prevent the major pitfalls of the process. As a digital age solution, they combine the best of the past and the present to allow for informed decision-making with maximum data interpretation ROI.

To start visualizing your insights in a meaningful and actionable way, test our online reporting software for free with our 14-day trial !

Library Guides

Dissertations 5: findings, analysis and discussion: home.

• Results/Findings

Alternative Structures

The time has come to show and discuss the findings of your research. How to structure this part of your dissertation? 

Dissertations can have different structures, as you can see in the dissertation  structure  guide.

Dissertations organised by sections

Many dissertations are organised by sections. In this case, we suggest three options. Note that, if within your course you have been instructed to use a specific structure, you should do that. Also note that sometimes there is considerable freedom on the structure, so you can come up with other structures too. 

A) More common for scientific dissertations and quantitative methods:

- Results chapter 

- Discussion chapter

Example: 

• Introduction
• Literature review
• Methodology
• (Recommendations)

if you write a scientific dissertation, or anyway using quantitative methods, you will have some  objective  results that you will present in the Results chapter. You will then interpret the results in the Discussion chapter.  

B) More common for qualitative methods

- Analysis chapter. This can have more descriptive/thematic subheadings.

- Discussion chapter. This can have more descriptive/thematic subheadings.

• Case study of Company X (fashion brand) environmental strategies 
• Successful elements
• Lessons learnt
• Criticisms of Company X environmental strategies 
• Possible alternatives

C) More common for qualitative methods

- Analysis and discussion chapter. This can have more descriptive/thematic titles.

• Case study of Company X (fashion brand) environmental strategies 

If your dissertation uses qualitative methods, it is harder to identify and report objective data. Instead, it may be more productive and meaningful to present the findings in the same sections where you also analyse, and possibly discuss, them. You will probably have different sections dealing with different themes. The different themes can be subheadings of the Analysis and Discussion (together or separate) chapter(s). 

Thematic dissertations

If the structure of your dissertation is thematic ,  you will have several chapters analysing and discussing the issues raised by your research. The chapters will have descriptive/thematic titles. 

• Background on the conflict in Yemen (2004-present day)
• Classification of the conflict in international law  
• International law violations
• Options for enforcement of international law
• Next: Results/Findings >>
• Last Updated: Aug 4, 2023 2:17 PM
• URL: https://libguides.westminster.ac.uk/c.php?g=696975

CONNECT WITH US

• How it works

Chapter 4 – Data Analysis and Discussion (example)

Disclaimer: This is not a sample of our professional work. The paper has been produced by a student. You can view samples of our work here . Opinions, suggestions, recommendations and results in this piece are those of the author and should not be taken as our company views.

Type of Academic Paper – Dissertation Chapter

Academic Subject – Marketing

Word Count – 2964 words

Reliability Analysis

Before conducting any analysis on the data, all the data’s reliability was analyzed based on Cronbach’s Alpha value. The reliability analysis was performed on the complete data of the questionnaire. The reliability of the data was found to be (0.922), as shown in the results of the reliability analysis provided below in table 4.1. However, the complete results output of the reliability analysis is given in the appendix.

Reliability Analysis (N=200)

The Cronbach’s Alpha value between (0.7-1.0) is considered to have excellent reliability. The Cronbach’s Alpha value of the data was found to be (0.922); therefore, this indicated that the questionnaire data had excellent reliability. All of the 29 items of the questionnaire had excellent reliability, and if they are taken for further analysis, they can generate results with 92.2% reliability.

Frequency Distribution Analysis

First of all, the frequency distribution analysis was performed on the demographic variables using SPSS to identify the respondents’ demographic composition. Section 1 of the questionnaire had 5 demographic questions to identify; gender, age group, annual income, marital status, and education level of the research sample. The frequency distribution results shown in table 4.2 below indicated that there were 200 respondents in total, out of which 50% were male, and 50% were female. This shows that the research sample was free from gender-based biases as males and females had equal representation in the sample.

Moreover, the frequency distribution analysis suggested three age groups; ‘20-35’, ‘36-60’ and ‘Above 60’. 39% of the respondents belonged to the ‘20-35’ age group, while 56.5% of the respondents belonged to the ‘36-60’ age group and the remaining 4.5% belonged to the age group of ‘Above 60’.

Furthermore, the annual income level was divided into four categories. The income values were in GBP. It was found that 13% of the respondents had income ‘up to 30000’, 27% had income between ‘31000 to 50000’, 52.5% had income between ‘51000 to 100000’, and 7.5% had income ‘Above 100000’. This suggests that most of the respondents had an annual income between ‘31000 to 50000’ GBP.

The frequency distribution analysis indicated that 61% of respondents were single, while 39% were married, as indicated in table 4.2. This means that most of the respondents were single. Based on frequency distribution, it was also found that the education level of the respondents was analyzed using four categories of education level, namely; diploma, graduate, master, and doctorate. The results depicted that 37% of the respondents were diploma holders, 46% were graduates, 16% had master-level education, while only 2% had a doctorate. This suggests that most of the respondents were either graduate or diploma holders.

Frequency Distribution of the Demographic Characteristics of the respondents (N=200)

Multiple Regression Analysis

The hypotheses were tested using linear multiple regression analysis to determine which of the dependent variables had a significant positive effect on the customer loyalty of the five-star hotel brands. The results of the regression analysis are summarized in the following table 4.3. However, the complete SPSS output of the regression analysis is given in the appendix. Table 4.3

Multiple regression analysis showing the predictive values of dependent variables (Brand image, corporate identity, public relation, perceived quality, and trustworthiness) on customer loyalty (N=200)

Predictors: (Constant), Trustworthiness, Public Relation, Brand Image, Corporate Identity, Perceived Quality Dependent Variable: Customer Loyalty

The significance value (p-value) of ANOVA was found to be (0.000) as shown in the above

table, which was less than 0.05. This suggested that the model equation was significantly fitted

on the data. Moreover, the adjusted R-Square value was (0.897), which indicated that the model’s predictors explained 89.7% variation in customer loyalty.

Furthermore, the presence of the significant effect of the 5 predicting variables on customer loyalty was identified based on their sig. Values. The effect of a predicting variable is significant if its sig. Value is less than 0.05 or if its t-Statistics value is greater than 2. It was found that the variable ‘brand image’ had sig. Value (0.046), the variable ‘corporate identity had sig. Value (0.482), the variable ‘public relation’ had sig. Value (0.400), while the variable ‘perceived quality’ had sig. value (0.000), and the variable ‘trustworthiness’ had sig. value (0.652).

Hire an Expert Dissertation Chapter Writer

Orders completed by our expert writers are

• Formally drafted in an academic style
• Free Amendments and 100% Plagiarism Free – or your money back!
• 100% Confidential and Timely Delivery!
• Free anti-plagiarism report
• Appreciated by thousands of clients. Check client reviews

Hypotheses Assessment

Based on the regression analysis, it was found that brand image and perceived quality have a significant positive effect on customer loyalty. In contrast, corporate identity, public relations, and trustworthiness have an insignificant effect on customer loyalty. Therefore the two hypotheses; H1 and H4 were accepted, however the three hypotheses; H2, H3, and H5 were rejected as indicated in table 4.4.

Hypothesis Assessment Summary Table (N=200)

The insignificant variables (corporate identity, public relation and trustworthiness) were excluded from equation 1. After excluding the insignificant variables from the model equation 1, the final equation becomes as follows;

Customer loyalty                 = α + 0.074 (Brand image) + 0.991 (Perceived quality) + €

The above equation suggests that a 1 unit increase in brand image is likely to result in 0.074 units increase customer loyalty. In comparison, 1 unit increase in perceived quality can result in 0.991 units increase in customer loyalty.

Cross Tabulation Analysis

To further explore the results, the demographic variables’ data were cross-tabulated against the respondents’ responses regarding customer loyalty using SPSS. In this regards the five demographic variables; gender, age group, annual income, marital status and education level were cross-tabulated against the five questions regarding customer loyalty to know the difference between the customer loyalty of five-star hotels of UK based on demographic differences. The results of the cross-tabulation analysis are given in the appendix. The results are graphically presented in bar charts too, which are also given in the appendix.

Cross Tabulation of Gender against Customer Loyalty

The gender was cross-tabulated against question 1 to 5 of the questionnaire to identify the gender differences between male and female respondents’ responses regarding customer loyalty of five-star hotels of the UK. The results indicated that out of 100 males, 57% were extremely agreed that they stay at one hotel, while out of 100 females, 80% were extremely agreed they stay at one hotel. This shows that in comparison with a male, females were more agreed that they stayed at one hotel and were found to be more loyal towards their respective hotel brands.

The cross-tabulation results further indicated that out of 100 males, 53% agreed that they always say positive things about their respective hotel brand to other people. In contrast, out of 100 females, 77% were extremely agreed. Based on the results, the females were found to be in more agreement than males that they always say positive things about their respective hotel brand to other people.

It was further found that out of 100 males, 53% were extremely agreed that they recommend their hotel brand to others, however, out of 100 females, 74% were extremely agreed to this statement. This result also suggested that females were more in agreement than males to recommend their hotel brand to others.

Moreover, it was found that out of 100 males, 54% were extremely agreed that they don’t seek alternative hotel brands, while out of 100 females, 79% were extremely agreed to this statement. This result also suggested that females were more agreed than males that they don’t seek alternative hotel brands, and so were found to be more loyal than males.

Furthermore, it was identified that out of 100 male respondents 56% were extremely agreed that they would continue to go to the same hotel irrespective of the prices, however out of 100 females 79% were extremely agreed. Based on this result, it was clear that females were more agreed than males that they would continue to go to the same hotel irrespective of the prices, so females were found to be more loyal than males.

After cross tabulating ‘gender’ against the response of the 5 questions regarding customer loyalty the females were found to be more loyal customers of the five-star hotel brands than males as they were found to be more in agreement than the man that they stay at one hotel, always say positive things about their hotel brand to other people, recommend their hotel brand to others, don’t seek alternative hotel brands and would continue to go to the same hotel irrespective of the prices.

Cross Tabulation of Age Group against Customer Loyalty

Afterward, the second demographic variable, ‘age groups’ was cross-tabulated against questions 1 to 5 of the questionnaire to identify the difference between the customer loyalty of customers of different age groups. The results indicated that out of 78 respondents between 20 to 35 years of age, 61.5% were extremely agreed that they stayed at one hotel. While out of 113 respondents who were between 36 to 60 years of age, 72.6% were extremely agreed that they always stay at one hotel. However, out of 9 respondents who were above 60 years of age, 77.8% agreed that they always stay at one hotel. This indicated that customers of 36-60 and above 60 age groups were more loyal to their hotel brands as they were keener to stay at a respective hotel brand.

Content removed…

Cross Tabulation of Annual Income against Customer Loyalty

The third demographic variable, ‘annual income’ was cross-tabulated against questions 1 to 5 of the questionnaire to identify which of the customers were most loyal based on their respective annual income levels. The results indicated that out of 26 respondents who had annual income up to 30000 GBP, 84.6% were extremely agreed that they always stay at one hotel. However, out of 54 respondents who had annual income from 31000 to 50000 GBP, 98.1% agreed that they always stay at one hotel. Although out of 105 respondents had annual income from 50000 to 100000 GBP, 49.5% were extremely agreed that they always stay at one hotel. While out of 10 respondents who had annual income from 50000 to 1000000 GBP, 66.7% agreed that they always stay at one hotel. This indicated that customers of annual income levels from 31000 to 50000 GBP were more loyal to their hotel brands than the customers having other annual income levels.

Cross Tabulation of Marital Status against Customer Loyalty

Furthermore, the fourth demographic variable the ‘marital status’ was cross-tabulated against questions 1 to 5 of the questionnaire to understand the difference between married and unmarried respondents regarding customer loyalty of five-star hotels of the UK. The cross-tabulation analysis results indicated that out of 122 single respondents, 59.8% were extremely agreed that they stay at one hotel. However, out of 78 married respondents, around 82% of respondents agreed that they stay at one hotel. Thus, the married customers were more loyal to their hotel brands than unmarried customers because, in comparison, married customers prefer to stay at one hotel brand.

To proceed with the cross-tabulation results, out of 122 single respondents, 55.7% were extremely agreed upon always saying positive things about their hotel brands to other people. On the other hand, out of 78 married respondents, 79.5% were extremely agreed. Hence, upon evaluating the results, it can be said that married customers have more customer loyalty as they are in more agreement than singles. They always give positive feedback regarding their respective hotel brand to other people.

Cross Tabulation of Education Level against Customer Loyalty

Subsequently, the fifth demographic variable, ‘education level’ was cross-tabulated against questions 1 to 5 of the questionnaire to identify which of the customers were most loyal based on their respective education levels. The results indicated that out of 50 respondents who were diploma holders, 67.6% were extremely agreed that they always stay at one hotel. While out of 64 respondents who were graduates, 69.6% were extremely agreed that they always stay at one hotel. Although out of 22 respondents who were masters, 68.8% were extremely agreed that they always stay at one hotel. However, out of 2 respondents with doctorates, 50% were extremely agreed to always stay at one hotel. This indicated that customers who were graduates were more loyal than the customers with diplomas, masters, or doctorates.

Moreover, 66.2% of the diploma holders were extremely agreed that they always say positive things about their hotel brand to other people. In comparison, 64.1% of the respondents who were graduates were extremely agreed. However, 65.5% of the respondents who had masters were extremely agreed, and 50% of the respondents who had doctorates agreed with the statement. Based on this result customers having masters were the most loyal customers of their respective five-star hotel brands.

Need a Dissertation Chapter On a Similar Topic?

In this subsection, the findings of this study are compared and contrasted with the literature to identify which of the past research supports the present research findings. This present study based on regression analysis suggested that brand image can have a significant positive effect on the customer loyalty of five-star hotels in the UK. This finding was supported by the research of Heung et al. (1996), who also suggested that the hotel’s brand image can play a vital role in preserving a high ratio of customer loyalty.

Moreover, this present study also suggested that perceived quality was the second factor that was found to have a significant positive effect on customer loyalty. The perceived quality was evaluated based on; service quality, comfort, staff courtesy, customer satisfaction, and service quality expectations. In this regard, Tat and Raymond (2000) research supports the findings of this study. The staff service quality was found to affect customer loyalty and the level of satisfaction. Teas (1994) had also found service quality to affect customer loyalty. However, Teas also found that staff empathy (staff courtesy) towards customers can also affect customer loyalty. The research of Rowley and Dawes (1999) also supports the finding of this present study. The users’ expectations about the quality and nature of the services affect customer loyalty. A study by Oberoi and Hales (1990) was found to agree with the present study’s findings, as they had found the quality of staff service to affect customer loyalty.

Summary of the Findings

• The brand image was found to have a significant positive effect on customer loyalty. Therefore customer loyalty is likely to increase with the increase in brand image.
• The corporate identity was found to have an insignificant effect on customer loyalty. Therefore customer loyalty is not likely to increase with the increase in corporate identity.
• Public relations was found to have an insignificant effect on customer loyalty. Therefore customer loyalty is not likely to increase with the increase in public relations.
• Perceived quality was found to have a significant positive effect on customer loyalty. Therefore customer loyalty is likely to increase with the increase in perceived quality.
• Trustworthiness was found to have an insignificant effect on customer loyalty. Therefore customer loyalty is not likely to increase with the increase in trustworthiness.
• The female customers were found to be more loyal customers of the five-star hotel brands than male customers.
• The customers of age from 36 to 60 years were more loyal to their hotel brands than the customers of age from 20 to 35 and above 60.
• The customers who had annual income from 31000 to 50000 were more loyal customers of their respective hotel brands than those who had an annual income level of less than 31000 or more than 50000.
• The married respondents had more customer loyalty than unmarried customers, towards five-star hotel brands of the UK.

The customers who had bachelor degrees and the customers who had master degrees were more loyal to the customers who had a diploma or doctorate.

Bryman, A., Bell, E., 2015. Business Research Methods. Oxford University Press.

Daum, P., 2013. International Synergy Management: A Strategic Approach for Raising Efficiencies in the Cross-border Interaction Process. Anchor Academic Publishing (aap_verlag).

Dümke, R., 2002. Corporate Reputation and its Importance for Business Success: A European

Perspective and its Implication for Public Relations Consultancies. diplom.de.

Guetterman, T.C., 2015. Descriptions of Sampling Practices Within Five Approaches to Qualitative Research in Education and the Health Sciences. Forum Qualitative Sozialforschung /

Forum: Qualitative Social Research 16.

Haq, M., 2014. A Comparative Analysis of Qualitative and Quantitative Research Methods and a Justification for Adopting Mixed Methods in Social Research (PDF Download Available).

ResearchGate 1–22. doi:http://dx.doi.org/10.13140/RG.2.1.1945.8640

Kelley, ., Clark, B., Brown, V., Sitzia, J., 2003. Good practice in the conduct and reporting of survey research. Int J Qual Health Care 15, 261–266. doi:10.1093/intqhc/mzg031

Lewis, S., 2015. Qualitative Inquiry and Research Design: Choosing Among Five Approaches.

Health Promotion Practice 16, 473–475. doi:10.1177/1524839915580941

Saunders, M., 2003. Research Methods for Business Students. Pearson Education India.

Saunders, M.N.K., Tosey, P., 2015. Handbook of Research Methods on Human Resource

Development. Edward Elgar Publishing.

DMCA / Removal Request

If you are the original writer of this Dissertation Chapter and no longer wish to have it published on the www.ResearchProspect.com then please:

Request The Removal Of This Dissertation Chapter

Frequently Asked Questions

How to write the results chapter of a dissertation.

To write the Results chapter of a dissertation:

• Present findings objectively.
• Use tables, graphs, or charts for clarity.
• Refer to research questions/hypotheses.
• Provide sufficient details.
• Avoid interpretation; save that for the Discussion chapter.

USEFUL LINKS

LEARNING RESOURCES

COMPANY DETAILS

• How It Works

• Open access
• Published: 13 May 2024

What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review

• Olivia R. Phillips 1 , 2   na1 ,
• Cerian Harries 2 , 3   na1 ,
• Jo Leonardi-Bee 1 , 2 , 4   na1 ,
• Holly Knight 1 , 2 ,
• Lauren B. Sherar 2 , 3 ,
• Veronica Varela-Mato 2 , 3 &
• Joanne R. Morling 1 , 2 , 5  

Research Involvement and Engagement volume  10 , Article number:  48 ( 2024 ) Cite this article

103 Accesses

2 Altmetric

Metrics details

There is increasing interest in using patient and public involvement (PPI) in research to improve the quality of healthcare. Ordinarily, traditional methods have been used such as interviews or focus groups. However, these methods tend to engage a similar demographic of people. Thus, creative methods are being developed to involve patients for whom traditional methods are inaccessible or non-engaging.

To determine the strengths and limitations to using creative PPI methods in health and social care research.

Electronic searches were conducted over five databases on 14th April 2023 (Web of Science, PubMed, ASSIA, CINAHL, Cochrane Library). Studies that involved traditional, non-creative PPI methods were excluded. Creative PPI methods were used to engage with people as research advisors, rather than study participants. Only primary data published in English from 2009 were accepted. Title, abstract and full text screening was undertaken by two independent reviewers before inductive thematic analysis was used to generate themes.

Twelve papers met the inclusion criteria. The creative methods used included songs, poems, drawings, photograph elicitation, drama performance, visualisations, social media, photography, prototype development, cultural animation, card sorting and persona development. Analysis identified four limitations and five strengths to the creative approaches. Limitations included the time and resource intensive nature of creative PPI, the lack of generalisation to wider populations and ethical issues. External factors, such as the lack of infrastructure to support creative PPI, also affected their implementation. Strengths included the disruption of power hierarchies and the creation of a safe space for people to express mundane or “taboo” topics. Creative methods are also engaging, inclusive of people who struggle to participate in traditional PPI and can also be cost and time efficient.

‘Creative PPI’ is an umbrella term encapsulating many different methods of engagement and there are strengths and limitations to each. The choice of which should be determined by the aims and requirements of the research, as well as the characteristics of the PPI group and practical limitations. Creative PPI can be advantageous over more traditional methods, however a hybrid approach could be considered to reap the benefits of both. Creative PPI methods are not widely used; however, this could change over time as PPI becomes embedded even more into research.

Plain English Summary

It is important that patients and public are included in the research process from initial brainstorming, through design to delivery. This is known as public and patient involvement (PPI). Their input means that research closely aligns with their wants and needs. Traditionally to get this input, interviews and group discussions are held, but this can exclude people who find these activities non-engaging or inaccessible, for example those with language challenges, learning disabilities or memory issues. Creative methods of PPI can overcome this. This is a broad term describing different (non-traditional) ways of engaging patients and public in research, such as through the use or art, animation or performance. This review investigated the reasons why creative approaches to PPI could be difficult (limitations) or helpful (strengths) in health and social care research. After searching 5 online databases, 12 studies were included in the review. PPI groups included adults, children and people with language and memory impairments. Creative methods included songs, poems, drawings, the use of photos and drama, visualisations, Facebook, creating prototypes, personas and card sorting. Limitations included the time, cost and effort associated with creative methods, the lack of application to other populations, ethical issues and buy-in from the wider research community. Strengths included the feeling of equality between academics and the public, creation of a safe space for people to express themselves, inclusivity, and that creative PPI can be cost and time efficient. Overall, this review suggests that creative PPI is worthwhile, however each method has its own strengths and limitations and the choice of which will depend on the research project, PPI group characteristics and other practical limitations, such as time and financial constraints.

Peer Review reports

Introduction

Patient and public involvement (PPI) is the term used to describe the partnership between patients (including caregivers, potential patients, healthcare users etc.) or the public (a community member with no known interest in the topic) with researchers. It describes research that is done “‘with’ or ‘by’ the public, rather than ‘to,’ ‘about’ or ‘for’ them” [ 1 ]. In 2009, it became a legislative requirement for certain health and social care organisations to include patients, families, carers and communities in not only the planning of health and social care services, but the commissioning, delivery and evaluation of them too [ 2 ]. For example, funding applications for the National Institute of Health and Care Research (NIHR), a UK funding body, mandates a demonstration of how researchers plan to include patients/service users, the public and carers at each stage of the project [ 3 ]. However, this should not simply be a tokenistic, tick-box exercise. PPI should help formulate initial ideas and should be an instrumental, continuous part of the research process. Input from PPI can provide unique insights not yet considered and can ensure that research and health services are closely aligned to the needs and requirements of service users PPI also generally makes research more relevant with clearer outcomes and impacts [ 4 ]. Although this review refers to both patients and the public using the umbrella term ‘PPI’, it is important to acknowledge that these are two different groups with different motivations, needs and interests when it comes to health research and service delivery [ 5 ].

Despite continuing recognition of the need of PPI to improve quality of healthcare, researchers have also recognised that there is no ‘one size fits all’ method for involving patients [ 4 ]. Traditionally, PPI methods invite people to take part in interviews or focus groups to facilitate discussion, or surveys and questionnaires. However, these can sometimes be inaccessible or non-engaging for certain populations. For example, someone with communication difficulties may find it difficult to engage in focus groups or interviews. If individuals lack the appropriate skills to interact in these types of scenarios, they cannot take advantage of the participation opportunities it can provide [ 6 ]. Creative methods, however, aim to resolve these issues. These are a relatively new concept whereby researchers use creative methods (e.g., artwork, animations, Lego), to make PPI more accessible and engaging for those whose voices would otherwise go unheard. They ensure that all populations can engage in research, regardless of their background or skills. Seminal work has previously been conducted in this area, which brought to light the use of creative methodologies in research. Leavy (2008) [ 7 ] discussed how traditional interviews had limits on what could be expressed due to their sterile, jargon-filled and formulaic structure, read by only a few specialised academics. It was this that called for more creative approaches, which included narrative enquiry, fiction-based research, poetry, music, dance, art, theatre, film and visual art. These practices, which can be used in any stage of the research cycle, supported greater empathy, self-reflection and longer-lasting learning experiences compared to interviews [ 7 ]. They also pushed traditional academic boundaries, which made the research accessible not only to researchers, but the public too. Leavy explains that there are similarities between arts-based approaches and scientific approaches: both attempts to investigate what it means to be human through exploration, and used together, these complimentary approaches can progress our understanding of the human experience [ 7 ]. Further, it is important to acknowledge the parallels and nuances between creative and inclusive methods of PPI. Although creative methods aim to be inclusive (this should underlie any PPI activity, whether creative or not), they do not incorporate all types of accessible, inclusive methodologies e.g., using sign language for people with hearing impairments or audio recordings for people who cannot read. Given that there was not enough scope to include an evaluation of all possible inclusive methodologies, this review will focus on creative methods of PPI only.

We aimed to conduct a qualitative systematic review to highlight the strengths of creative PPI in health and social care research, as well as the limitations, which might act as a barrier to their implementation. A qualitative systematic review “brings together research on a topic, systematically searching for research evidence from primary qualitative studies and drawing the findings together” [ 8 ]. This review can then advise researchers of the best practices when designing PPI.

Public involvement

The PHIRST-LIGHT Public Advisory Group (PAG) consists of a team of experienced public contributors with a diverse range of characteristics from across the UK. The PAG was involved in the initial question setting and study design for this review.

Search strategy

For the purpose of this review, the JBI approach for conducting qualitative systematic reviews was followed [ 9 ]. The search terms were (“creativ*” OR “innovat*” OR “authentic” OR “original” OR “inclu*”) AND (“public and patient involvement” OR “patient and public involvement” OR “public and patient involvement and engagement” OR “patient and public involvement and engagement” OR “PPI” OR “PPIE” OR “co-produc*” OR “co-creat*” OR “co-design*” OR “cooperat*” OR “co-operat*”). This search string was modified according to the requirements of each database. Papers were filtered by title, abstract and keywords (see Additional file 1 for search strings). The databases searched included Web of Science (WoS), PubMed, ASSIA and CINAHL. The Cochrane Library was also searched to identify relevant reviews which could lead to the identification of primary research. The search was conducted on 14/04/23. As our aim was to report on the use of creative PPI in research, rather than more generic public engagement, we used electronic databases of scholarly peer-reviewed literature, which represent a wide range of recognised databases. These identified studies published in general international journals (WoS, PubMed), those in social sciences journals (ASSIA), those in nursing and allied health journals (CINAHL), and trials of interventions (Cochrane Library).

Inclusion criteria

Only full-text, English language, primary research papers from 2009 to 2023 were included. This was the chosen timeframe as in 2009 the Health and Social Reform Act made it mandatory for certain Health and Social Care organisations to involve the public and patients in planning, delivering, and evaluating services [ 2 ]. Only creative methods of PPI were accepted, rather than traditional methods, such as interviews or focus groups. For the purposes of this paper, creative PPI included creative art or arts-based approaches (e.g., e.g. stories, songs, drama, drawing, painting, poetry, photography) to enhance engagement. Titles were related to health and social care and the creative PPI was used to engage with people as research advisors, not as study participants. Meta-analyses, conference abstracts, book chapters, commentaries and reviews were excluded. There were no limits concerning study location or the demographic characteristics of the PPI groups. Only qualitative data were accepted.

Quality appraisal

Quality appraisal using the Critical Appraisal Skills Programme (CASP) checklist [ 10 ] was conducted by the primary authors (ORP and CH). This was done independently, and discrepancies were discussed and resolved. If a consensus could not be reached, a third independent reviewer was consulted (JRM). The full list of quality appraisal questions can be found in Additional file 2 .

Data extraction

ORP extracted the study characteristics and a subset of these were checked by CH. Discrepancies were discussed and amendments made. Extracted data included author, title, location, year of publication, year study was carried out, research question/aim, creative methods used, number of participants, mean age, gender, ethnicity of participants, setting, limitations and strengths of creative PPI and main findings.

Data analysis

The included studies were analysed using inductive thematic analysis [ 11 ], where themes were determined by the data. The familiarisation stage took place during full-text reading of the included articles. Anything identified as a strength or limitation to creative PPI methods was extracted verbatim as an initial code and inputted into the data extraction Excel sheet. Similar codes were sorted into broader themes, either under ‘strengths’ or ‘limitations’ and reviewed. Themes were then assigned a name according to the codes.

The search yielded 9978 titles across the 5 databases: Web of Science (1480 results), PubMed (94 results), ASSIA (2454 results), CINAHL (5948 results) and Cochrane Library (2 results), resulting in 8553 different studies after deduplication. ORP and CH independently screened their titles and abstracts, excluding those that did not meet the criteria. After assessment, 12 studies were included (see Fig.  1 ).

PRISMA flowchart of the study selection process

Study characteristics

The included studies were published between 2018 and 2022. Seven were conducted in the UK [ 12 , 14 , 15 , 17 , 18 , 19 , 23 ], two in Canada [ 21 , 22 ], one in Australia [ 13 ], one in Norway [ 16 ] and one in Ireland [ 20 ]. The PPI activities occurred across various settings, including a school [ 12 ], social club [ 12 ], hospital [ 17 ], university [ 22 ], theatre [ 19 ], hotel [ 20 ], or online [ 15 , 21 ], however this information was omitted in 5 studies [ 13 , 14 , 16 , 18 , 23 ]. The number of people attending the PPI sessions varied, ranging from 6 to 289, however the majority (ten studies) had less than 70 participants [ 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Seven studies did not provide information on the age or gender of the PPI groups. Of those that did, ages ranged from 8 to 76 and were mostly female. The ethnicities of the PPI group members were also rarely recorded (see Additional file 3 for data extraction table).

Types of creative methods

The type of creative methods used to engage the PPI groups were varied. These included songs, poems, drawings, photograph elicitation, drama performance, visualisations, Facebook, photography, prototype development, cultural animation, card sorting and creating personas (see Table  1 ). These were sometimes accompanied by traditional methods of PPI such as interviews and focus group discussions.

The 12 included studies were all deemed to be of good methodological quality, with scores ranging from 6/10 to 10/10 with the CASP critical appraisal tool [ 10 ] (Table  2 ).

Thematic analysis

Analysis identified four limitations and five strengths to creative PPI (see Fig.  2 ). Limitations included the time and resource intensity of creative PPI methods, its lack of generalisation, ethical issues and external factors. Strengths included the disruption of power hierarchies, the engaging and inclusive nature of the methods and their long-term cost and time efficiency. Creative PPI methods also allowed mundane and “taboo” topics to be discussed within a safe space.

Theme map of strengths and limitations

Limitations of creative PPI

Creative ppi methods are time and resource intensive.

The time and resource intensive nature of creative PPI methods is a limitation, most notably for the persona-scenario methodology. Valaitis et al. [ 22 ] used 14 persona-scenario workshops with 70 participants to co-design a healthcare intervention, which aimed to promote optimal aging in Canada. Using the persona method, pairs composed of patients, healthcare providers, community service providers and volunteers developed a fictional character which they believed represented an ‘end-user’ of the healthcare intervention. Due to the depth and richness of the data produced the authors reported that it was time consuming to analyse. Further, they commented that the amount of information was difficult to disseminate to scientific leads and present at team meetings. Additionally, to ensure the production of high-quality data, to probe for details and lead group discussion there was a need for highly skilled facilitators. The resource intensive nature of the creative co-production was also noted in a study using the persona scenario and creative worksheets to develop a prototype decision support tool for individuals with malignant pleural effusion [ 17 ]. With approximately 50 people, this was also likely to yield a high volume of data to consider.

To prepare materials for populations who cannot engage in traditional methods of PPI was also timely. Kearns et al. [ 18 ] developed a feedback questionnaire for people with aphasia to evaluate ICT-delivered rehabilitation. To ensure people could participate effectively, the resources used during the workshops, such as PowerPoints, online images and photographs, had to be aphasia-accessible, which was labour and time intensive. The author warned that this time commitment should not be underestimated.

There are further practical limitations to implementing creative PPI, such as the costs of materials for activities as well as hiring a space for workshops. For example, the included studies in this review utilised pens, paper, worksheets, laptops, arts and craft supplies and magazines and took place in venues such as universities, a social club, and a hotel. Further, although not limited to creative PPI methods exclusively but rather most studies involving the public, a financial incentive was often offered for participation, as well as food, parking, transport and accommodation [ 21 , 22 ].

Creative PPI lacks generalisation

Another barrier to the use of creative PPI methods in health and social care research was the individual nature of its output. Those who participate, usually small in number, produce unique creative outputs specific to their own experiences, opinions and location. Craven et al. [ 13 ], used arts-based visualisations to develop a toolbox for adults with mental health difficulties. They commented, “such an approach might still not be worthwhile”, as the visualisations were individualised and highly personal. This indicates that the output may fail to meet the needs of its end-users. Further, these creative PPI groups were based in certain geographical regions such as Stoke-on-Trent [ 19 ] Sheffield [ 23 ], South Wales [ 12 ] or Ireland [ 20 ], which limits the extent the findings can be applied to wider populations, even within the same area due to individual nuances. Further, the study by Galler et al. [ 16 ], is specific to the Norwegian context and even then, maybe only a sub-group of the Norwegian population as the sample used was of higher socioeconomic status.

However, Grindell et al. [ 17 ], who used persona scenarios, creative worksheets and prototype development, pointed out that the purpose of this type of research is to improve a certain place, rather than apply findings across other populations and locations. Individualised output may, therefore, only be a limitation to research wanting to conduct PPI on a large scale.

If, however, greater generalisation within PPI is deemed necessary, then social media may offer a resolution. Fedorowicz et al. [ 15 ], used Facebook to gain feedback from the public on the use of video-recording methodology for an upcoming project. This had the benefit of including a more diverse range of people (289 people joined the closed group), who were spread geographically around the UK, as well as seven people from overseas.

Creative PPI has ethical issues

As with other research, ethical issues must be taken into consideration. Due to the nature of creative approaches, as well as the personal effort put into them, people often want to be recognised for their work. However, this compromises principles so heavily instilled in research such as anonymity and confidentiality. With the aim of exploring issues related to health and well-being in a town in South Wales, Byrne et al. [ 12 ], asked year 4/5 and year 10 pupils to create poems, songs, drawings and photographs. Community members also created a performance, mainly of monologues, to explore how poverty and inequalities are dealt with. Byrne noted the risks of these arts-based approaches, that being the possibility of over-disclosure and consequent emotional distress, as well as people’s desire to be named for their work. On one hand, the anonymity reduces the sense of ownership of the output as it does not portray a particular individual’s lived experience anymore. On the other hand, however, it could promote a more honest account of lived experience. Supporting this, Webber et al. [ 23 ], who used the persona method to co-design a back pain educational resource prototype, claimed that the anonymity provided by this creative technique allowed individuals to externalise and anonymise their own personal experience, thus creating a more authentic and genuine resource for future users. This implies that anonymity can be both a limitation and strength here.

The use of creative PPI methods is impeded by external factors

Despite the above limitations influencing the implementation of creative PPI techniques, perhaps the most influential is that creative methodologies are simply not mainstream [ 19 ]. This could be linked to the issues above, like time and resource intensity, generalisation and ethical issues but it is also likely to involve more systemic factors within the research community. Micsinszki et al. [ 21 ], who co-designed a hub for the health and well-being of vulnerable populations, commented that there is insufficient infrastructure to conduct meaningful co-design as well as a dominant medical model. Through a more holistic lens, there are “sociopolitical environments that privilege individualism over collectivism, self-sufficiency over collaboration, and scientific expertise over other ways of knowing based on lived experience” [ 21 ]. This, it could be suggested, renders creative co-design methodologies, which are based on the foundations of collectivism, collaboration and imagination an invalid technique in the research field, which is heavily dominated by more scientific methods offering reproducibility, objectivity and reliability.

Although we acknowledge that creative PPI techniques are not always appropriate, it may be that their main limitation is the lack of awareness of these methods or lack of willingness to use them. Further, there is always the risk that PPI, despite being a mandatory part of research, is used in a tokenistic or tick-box fashion [ 20 ], without considering the contribution that meaningful PPI could make to enhancing the research. It may be that PPI, let alone creative PPI, is not at the forefront of researchers’ minds when planning research.

Strengths of creative PPI

Creative ppi disrupts power hierarchies.

One of the main strengths of creative PPI techniques, cited most frequently in the included literature, was that they disrupt traditional power hierarchies [ 12 , 13 , 17 , 19 , 23 ]. For example, the use of theatre performance blurred the lines between professional and lay roles between the community and policy makers [ 12 ]. Individuals created a monologue to portray how poverty and inequality impact daily life and presented this to representatives of the National Assembly of Wales, Welsh Government, the Local Authority, Arts Council and Westminster. Byrne et al. [ 12 ], states how this medium allowed the community to engage with the people who make decisions about their lives in an environment of respect and understanding, where the hierarchies are not as visible as in other settings, e.g., political surgeries. Creative PPI methods have also removed traditional power hierarchies between researchers and adolescents. Cook et al. [ 13 ], used arts-based approaches to explore adolescents’ ideas about the “perfect” condom. They utilised the “Life Happens” resource, where adolescents drew and then decorated a person with their thoughts about sexual relationships, not too dissimilar from the persona-scenario method. This was then combined with hypothetical scenarios about sexuality. A condom-mapping exercise was then implemented, where groups shared the characteristics that make a condom “perfect” on large pieces of paper. Cook et al. [ 13 ], noted that usually power imbalances make it difficult to elicit information from adolescents, however these power imbalances were reduced due to the use of creative co-design techniques.

The same reduction in power hierarchies was noted by Grindell et al. [ 17 ], who used the person-scenario method and creative worksheets with individuals with malignant pleural effusion. This was with the aim of developing a prototype of a decision support tool for patients to help with treatment options. Although this process involved a variety of stakeholders, such as patients, carers and healthcare professionals, creative co-design was cited as a mechanism that worked to reduce power imbalances – a limitation of more traditional methods of research. Creative co-design blurred boundaries between end-users and clinical staff and enabled the sharing of ideas from multiple, valuable perspectives, meaning the prototype was able to suit user needs whilst addressing clinical problems.

Similarly, a specific creative method named cultural animation was also cited to dissolve hierarchies and encourage equal contributions from participants. Within this arts-based approach, Keleman et al. [ 19 ], explored the concept of “good health” with individuals from Stoke-on Trent. Members of the group created art installations using ribbons, buttons, cardboard and straws to depict their idea of a “healthy community”, which was accompanied by a poem. They also created a 3D Facebook page and produced another poem or song addressing the government to communicate their version of a “picture of health”. Public participants said that they found the process empowering, honest, democratic, valuable and practical.

This dissolving of hierarchies and levelling of power is beneficial as it increases the sense of ownership experienced by the creators/producers of the output [ 12 , 17 , 23 ]. This is advantageous as it has been suggested to improve its quality [ 23 ].

Creative PPI allows the unsayable to be said

Creative PPI fosters a safe space for mundane or taboo topics to be shared, which may be difficult to communicate using traditional methods of PPI. For example, the hypothetical nature of condom mapping and persona-scenarios meant that adolescents could discuss a personal topic without fear of discrimination, judgement or personal disclosure [ 13 ]. The safe space allowed a greater volume of ideas to be generated amongst peers where they might not have otherwise. Similarly, Webber et al. [ 23 ], , who used the persona method to co-design the prototype back pain educational resource, also noted how this method creates anonymity whilst allowing people the opportunity to externalise personal experiences, thoughts and feelings. Other creative methods were also used, such as drawing, collaging, role play and creating mood boards. A cardboard cube (labelled a “magic box”) was used to symbolise a physical representation of their final prototype. These creative methods levelled the playing field and made personal experiences accessible in a safe, open environment that fostered trust, as well as understanding from the researchers.

It is not only sensitive subjects that were made easier to articulate through creative PPI. The communication of mundane everyday experiences were also facilitated, which were deemed typically ‘unsayable’. This was specifically given in the context of describing intangible aspects of everyday health and wellbeing [ 11 ]. Graphic designers can also be used to visually represent the outputs of creative PPI. These captured the movement and fluidity of people and well as the relationships between them - things that cannot be spoken but can be depicted [ 21 ].

Creative PPI methods are inclusive

Another strength of creative PPI was that it is inclusive and accessible [ 17 , 19 , 21 ]. The safe space it fosters, as well as the dismantling of hierarchies, welcomed people from a diverse range of backgrounds and provided equal opportunities [ 21 ], especially for those with communication and memory difficulties who might be otherwise excluded from PPI. Kelemen et al. [ 19 ], who used creative methods to explore health and well-being in Stoke-on-Trent, discussed how people from different backgrounds came together and connected, discussed and reached a consensus over a topic which evoked strong emotions, that they all have in common. Individuals said that the techniques used “sets people to open up as they are not overwhelmed by words”. Similarly, creative activities, such as the persona method, have been stated to allow people to express themselves in an inclusive environment using a common language. Kearns et al. [ 18 ], who used aphasia-accessible material to develop a questionnaire with aphasic individuals, described how they felt comfortable in contributing to workshops (although this material was time-consuming to make, see ‘Limitations of creative PPI’ ).

Despite the general inclusivity of creative PPI, it can also be exclusive, particularly if online mediums are used. Fedorowicz et al. [ 15 ], used Facebook to create a PPI group, and although this may rectify previous drawbacks about lack of generalisation of creative methods (as Facebook can reach a greater number of people, globally), it excluded those who are not digitally active or have limited internet access or knowledge of technology. Online methods have other issues too. Maintaining the online group was cited as challenging and the volume of responses required researchers to interact outside of their working hours. Despite this, online methods like Facebook are very accessible for people who are physically disabled.

Creative PPI methods are engaging

The process of creative PPI is typically more engaging and produces more colourful data than traditional methods [ 13 ]. Individuals are permitted and encouraged to explore a creative self [ 19 ], which can lead to the exploration of new ideas and an overall increased enjoyment of the process. This increased engagement is particularly beneficial for younger PPI groups. For example, to involve children in the development of health food products, Galler et al. [ 16 ] asked 9-12-year-olds to take photos of their food and present it to other children in a “show and tell” fashion. They then created a newspaper article describing a new healthy snack. In this creative focus group, children were given lab coats to further their identity as inventors. Galler et al. [ 16 ], notes that the methods were highly engaging and facilitated teamwork and group learning. This collaborative nature of problem-solving was also observed in adults who used personas and creative worksheets to develop the resource for lower back pain [ 23 ]. Dementia patients too have been reported to enjoy the creative and informal approach to idea generation [ 20 ].

The use of cultural animation allowed people to connect with each other in a way that traditional methods do not [ 19 , 21 ]. These connections were held in place by boundary objects, such as ribbons, buttons, fabric and picture frames, which symbolised a shared meaning between people and an exchange of knowledge and emotion. Asking groups to create an art installation using these objects further fostered teamwork and collaboration, both at an individual and collective level. The exploration of a creative self increased energy levels and encouraged productive discussions and problem-solving [ 19 ]. Objects also encouraged a solution-focused approach and permitted people to think beyond their usual everyday scope [ 17 ]. They also allowed facilitators to probe deeper about the greater meanings carried by the object, which acted as a metaphor [ 21 ].

From the researcher’s point of view, co-creative methods gave rise to ideas they might not have initially considered. Valaitis et al. [ 22 ], found that over 40% of the creative outputs were novel ideas brought to light by patients, healthcare providers/community care providers, community service providers and volunteers. One researcher commented, “It [the creative methods] took me on a journey, in a way that when we do other pieces of research it can feel disconnected” [ 23 ]. Another researcher also stated they could not return to the way they used to do research, as they have learnt so much about their own health and community and how they are perceived [ 19 ]. This demonstrates that creative processes not only benefit the project outcomes and the PPI group, but also facilitators and researchers. However, although engaging, creative methods have been criticised for not demonstrating academic rigour [ 17 ]. Moreover, creative PPI may also be exclusive to people who do not like or enjoy creative activities.

Creative PPI methods are cost and time efficient

Creative PPI workshops can often produce output that is visible and tangible. This can save time and money in the long run as the output is either ready to be implemented in a healthcare setting or a first iteration has already been developed. This may also offset the time and costs it takes to implement creative PPI. For example, the prototype of the decision support tool for people with malignant pleural effusion was developed using personas and creative worksheets. The end result was two tangible prototypes to drive the initial idea forward as something to be used in practice [ 17 ]. The use of creative co-design in this case saved clinician time as well as the time it would take to develop this product without the help of its end-users. In the development of this particular prototype, analysis was iterative and informed the next stage of development, which again saved time. The same applies for the feedback questionnaire for the assessment of ICT delivered aphasia rehabilitation. The co-created questionnaire, designed with people with aphasia, was ready to be used in practice [ 18 ]. This suggests that to overcome time and resource barriers to creative PPI, researchers should aim for it to be engaging whilst also producing output.

That useable products are generated during creative workshops signals to participating patients and public members that they have been listened to and their thoughts and opinions acted upon [ 23 ]. For example, the development of the back pain resource based on patient experiences implies that their suggestions were valid and valuable. Further, those who participated in the cultural animation workshop reported that the process visualises change, and that it already feels as though the process of change has started [ 19 ].

The most cost and time efficient method of creative PPI in this review is most likely the use of Facebook to gather feedback on project methodology [ 15 ]. Although there were drawbacks to this, researchers could involve more people from a range of geographical areas at little to no cost. Feedback was instantaneous and no training was required. From the perspective of the PPI group, they could interact however much or little they wish with no time commitment.

This systematic review identified four limitations and five strengths to the use of creative PPI in health and social care research. Creative PPI is time and resource intensive, can raise ethical issues and lacks generalisability. It is also not accepted by the mainstream. These factors may act as barriers to the implementation of creative PPI. However, creative PPI disrupts traditional power hierarchies and creates a safe space for taboo or mundane topics. It is also engaging, inclusive and can be time and cost efficient in the long term.

Something that became apparent during data analysis was that these are not blanket strengths and limitations of creative PPI as a whole. The umbrella term ‘creative PPI’ is broad and encapsulates a wide range of activities, ranging from music and poems to prototype development and persona-scenarios, to more simplistic things like the use of sticky notes and ordering cards. Many different activities can be deemed ‘creative’ and the strengths and limitations of one does not necessarily apply to another. For example, cultural animation takes greater effort to prepare than the use of sticky notes and sorting cards, and the use of Facebook is cheaper and wider reaching than persona development. Researchers should use their discretion and weigh up the benefits and drawbacks of each method to decide on a technique which suits the project. What might be a limitation to creative PPI in one project may not be in another. In some cases, creative PPI may not be suitable at all.

Furthermore, the choice of creative PPI method also depends on the needs and characteristics of the PPI group. Children, adults and people living with dementia or language difficulties all have different engagement needs and capabilities. This indicates that creative PPI is not one size fits all and that the most appropriate method will change depending on the composition of the group. The choice of method will also be determined by the constraints of the research project, namely time, money and the research aim. For example, if there are time constraints, then a method which yields a lot of data and requires a lot of preparation may not be appropriate. If generalisation is important, then an online method is more suitable. Together this indicates that the choice of creative PPI method is highly individualised and dependent on multiple factors.

Although the limitations discussed in this review apply to creative PPI, they are not exclusive to creative PPI. Ethical issues are a consideration within general PPI research, especially when working with more vulnerable populations, such as children or adults living with a disability. It can also be the case that traditional PPI methods lack generalisability, as people who volunteer to be part of such a group are more likely be older, middle class and retired [ 24 ]. Most research is vulnerable to this type of bias, however, it is worth noting that generalisation is not always a goal and research remains valid and meaningful in its absence. Although online methods may somewhat combat issues related to generalisability, these methods still exclude people who do not have access to the internet/technology or who choose not to use it, implying that online PPI methods may not be wholly representative of the general population. Saying this, however, the accessibility of creative PPI techniques differs from person to person, and for some, online mediums may be more accessible (for example for those with a physical disability), and for others, this might be face-to-face. To combat this, a range of methods should be implemented. Planning multiple focus group and interviews for traditional PPI is also time and resource intensive, however the extra resources required to make this creative may be even greater. Although, the rich data provided may be worth the preparation and analysis time, which is also likely to depend on the number of participants and workshop sessions required. PPI, not just creative PPI, often requires the provision of a financial incentive, refreshments, parking and accommodation, which increase costs. These, however, are imperative and non-negotiable, as they increase the accessibility of research, especially to minority and lower-income groups less likely to participate. Adequate funding is also important for co-design studies where repeated engagement is required. One barrier to implementation, which appears to be exclusive to creative methods, however, is that creative methods are not mainstream. This cannot be said for traditional PPI as this is often a mandatory part of research applications.

Regarding the strengths of creative PPI, it could be argued that most appear to be exclusive to creative methodologies. These are inclusive by nature as multiple approaches can be taken to evoke ideas from different populations - approaches that do not necessarily rely on verbal or written communication like interviews and focus groups do. Given the anonymity provided by some creative methods, such as personas, people may be more likely to discuss their personal experiences under the guise of a general end-user, which might be more difficult to maintain when an interviewer is asking an individual questions directly. Additionally, creative methods are by nature more engaging and interactive than traditional methods, although this is a blanket statement and there may be people who find the question-and-answer/group discussion format more engaging. Creative methods have also been cited to eliminate power imbalances which exist in traditional research [ 12 , 13 , 17 , 19 , 23 ]. These imbalances exist between researchers and policy makers and adolescents, adults and the community. Lastly, although this may occur to a greater extent in creative methods like prototype development, it could be suggested that PPI in general – regardless of whether it is creative - is more time and cost efficient in the long-term than not using any PPI to guide or refine the research process. It must be noted that these are observations based on the literature. To be certain these differences exist between creative and traditional methods of PPI, direct empirical evaluation of both should be conducted.

To the best of our knowledge, this is the first review to identify the strengths and limitations to creative PPI, however, similar literature has identified barriers and facilitators to PPI in general. In the context of clinical trials, recruitment difficulties were cited as a barrier, as well as finding public contributors who were free during work/school hours. Trial managers reported finding group dynamics difficult to manage and the academic environment also made some public contributors feel nervous and lacking confidence to speak. Facilitators, however, included the shared ownership of the research – something that has been identified in the current review too. In addition, planning and the provision of knowledge, information and communication were also identified as facilitators [ 25 ]. Other research on the barriers to meaningful PPI in trial oversight committees included trialist confusion or scepticism over the PPI role and the difficulties in finding PPI members who had a basic understanding of research [ 26 ]. However, it could be argued that this is not representative of the average patient or public member. The formality of oversight meetings and the technical language used also acted as a barrier, which may imply that the informal nature of creative methods and its lack of dependency on literacy skills could overcome this. Further, a review of 42 reviews on PPI in health and social care identified financial compensation, resources, training and general support as necessary to conduct PPI, much like in the current review where the resource intensiveness of creative PPI was identified as a limitation. However, others were identified too, such as recruitment and representativeness of public contributors [ 27 ]. Like in the current review, power imbalances were also noted, however this was included as both a barrier and facilitator. Collaboration seemed to diminish hierarchies but not always, as sometimes these imbalances remained between public contributors and healthcare staff, described as a ‘them and us’ culture [ 27 ]. Although these studies compliment the findings of the current review, a direct comparison cannot be made as they do not concern creative methods. However, it does suggest that some strengths and weaknesses are shared between creative and traditional methods of PPI.

Strengths and limitations of this review

Although a general definition of creative PPI exists, it was up to our discretion to decide exactly which activities were deemed as such for this review. For example, we included sorting cards, the use of interactive whiteboards and sticky notes. Other researchers may have a more or less stringent criteria. However, two reviewers were involved in this decision which aids the reliability of the included articles. Further, it may be that some of the strengths and limitations cannot fully be attributed to the creative nature of the PPI process, but rather their co-created nature, however this is hard to disentangle as the included papers involved both these aspects.

During screening, it was difficult to decide whether the article was utilising creative qualitative methodology or creative PPI , as it was often not explicitly labelled as such. Regardless, both approaches involved the public/patients refining a healthcare product/service. This implies that if this review were to be replicated, others may do it differently. This may call for greater standardisation in the reporting of the public’s involvement in research. For example, the NIHR outlines different approaches to PPI, namely “consultation”, “collaboration”, “co-production” and “user-controlled”, which each signify an increased level of public power and influence [ 28 ]. Papers with elements of PPI could use these labels to clarify the extent of public involvement, or even explicitly state that there was no PPI. Further, given our decision to include only scholarly peer-reviewed literature, it is possible that data were missed within the grey literature. Similarly, the literature search will not have identified all papers relating to different types of accessible inclusion. However, the intent of the review was to focus solely on those within the definition of creative.

This review fills a gap in the literature and helps circulate and promote the concept of creative PPI. Each stage of this review, namely screening and quality appraisal, was conducted by two independent reviewers. However, four full texts could not be accessed during the full text reading stage, meaning there are missing data that could have altered or contributed to the findings of this review.

Research recommendations

Given that creative PPI can require effort to prepare, perform and analyse, sufficient time and funding should be allocated in the research protocol to enable meaningful and continuous PPI. This is worthwhile as PPI can significantly change the research output so that it aligns closely with the needs of the group it is to benefit. Researchers should also consider prototype development as a creative PPI activity as this might reduce future time/resource constraints. Shifting from a top-down approach within research to a bottom-up can be advantageous to all stakeholders and can help move creative PPI towards the mainstream. This, however, is the collective responsibility of funding bodies, universities and researchers, as well as committees who approve research bids.

A few of the included studies used creative techniques alongside traditional methods, such as interviews, which could also be used as a hybrid method of PPI, perhaps by researchers who are unfamiliar with creative techniques or to those who wish to reap the benefits of both. Often the characteristics of the PPI group were not included, including age, gender and ethnicity. It would be useful to include such information to assess how representative the PPI group is of the population of interest.

Creative PPI is a relatively novel approach of engaging the public and patients in research and it has both advantages and disadvantages compared to more traditional methods. There are many approaches to implementing creative PPI and the choice of technique will be unique to each piece of research and is reliant on several factors. These include the age and ability of the PPI group as well as the resource limitations of the project. Each method has benefits and drawbacks, which should be considered at the protocol-writing stage. However, given adequate funding, time and planning, creative PPI is a worthwhile and engaging method of generating ideas with end-users of research – ideas which may not be otherwise generated using traditional methods.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Critical Appraisal Skills Programme

The Joanna Briggs Institute

National Institute of Health and Care Research

Public Advisory Group

Public and Patient Involvement

Web of Science

National Institute for Health and Care Research. What Is Patient and Public Involvement and Public Engagement? https://www.spcr.nihr.ac.uk/PPI/what-is-patient-and-public-involvement-and-engagement Accessed 01 Sept 2023.

Department of Health. Personal and Public Involvement (PPI) https://www.health-ni.gov.uk/topics/safety-and-quality-standards/personal-and-public-involvement-ppi#:~:text=The Health and Social Care Reform Act (NI) 2009 placed,delivery and evaluation of services . Accessed 01 Sept 2023.

National Institute for Health and Care Research. Policy Research Programme – Guidance for Stage 1 Applications https://www.nihr.ac.uk/documents/policy-research-programme-guidance-for-stage-1-applications-updated/26398 Accessed 01 Sept 2023.

Greenhalgh T, Hinton L, Finlay T, Macfarlane A, Fahy N, Clyde B, Chant A. Frameworks for supporting patient and public involvement in research: systematic review and co-design pilot. Health Expect. 2019. https://doi.org/10.1111/hex.12888

Article   PubMed   PubMed Central   Google Scholar  

Street JM, Stafinski T, Lopes E, Menon D. Defining the role of the public in health technology assessment (HTA) and HTA-informed decision-making processes. Int J Technol Assess Health Care. 2020. https://doi.org/10.1017/S0266462320000094

Article   PubMed   Google Scholar  

Morrison C, Dearden A. Beyond tokenistic participation: using representational artefacts to enable meaningful public participation in health service design. Health Policy. 2013. https://doi.org/10.1016/j.healthpol.2013.05.008

Leavy P. Method meets art: arts-Based Research Practice. New York: Guilford; 2020.

Google Scholar  

Seers K. Qualitative systematic reviews: their importance for our understanding of research relevant to pain. Br J Pain. 2015. https://doi.org/10.1177/2049463714549777

Lockwood C, Porritt K, Munn Z, Rittenmeyer L, Salmond S, Bjerrum M, Loveday H, Carrier J, Stannard D. Chapter 2: Systematic reviews of qualitative evidence. Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis JBI. 2020. https://synthesismanual.jbi.global . https://doi.org/10.46658/JBIMES-20-03

CASP. CASP Checklists https://casp-uk.net/images/checklist/documents/CASP-Qualitative-Studies-Checklist/CASP-Qualitative-Checklist-2018_fillable_form.pdf (2022).

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006. https://doi.org/10.1191/1478088706qp063oa

Article   Google Scholar  

Byrne E, Elliott E, Saltus R, Angharad J. The creative turn in evidence for public health: community and arts-based methodologies. J Public Health. 2018. https://doi.org/10.1093/pubmed/fdx151

Cook S, Grozdanovski L, Renda G, Santoso D, Gorkin R, Senior K. Can you design the perfect condom? Engaging young people to inform safe sexual health practice and innovation. Sex Educ. 2022. https://doi.org/10.1080/14681811.2021.1891040

Craven MP, Goodwin R, Rawsthorne M, Butler D, Waddingham P, Brown S, Jamieson M. Try to see it my way: exploring the co-design of visual presentations of wellbeing through a workshop process. Perspect Public Health. 2019. https://doi.org/10.1177/1757913919835231

Fedorowicz S, Riley V, Cowap L, Ellis NJ, Chambers R, Grogan S, Crone D, Cottrell E, Clark-Carter D, Roberts L, Gidlow CJ. Using social media for patient and public involvement and engagement in health research: the process and impact of a closed Facebook group. Health Expect. 2022. https://doi.org/10.1111/hex.13515

Galler M, Myhrer K, Ares G, Varela P. Listening to children voices in early stages of new product development through co-creation – creative focus group and online platform. Food Res Int. 2022. https://doi.org/10.1016/j.foodres.2022.111000

Grindell C, Tod A, Bec R, Wolstenholme D, Bhatnagar R, Sivakumar P, Morley A, Holme J, Lyons J, Ahmed M, Jackson S, Wallace D, Noorzad F, Kamalanathan M, Ahmed L, Evison M. Using creative co-design to develop a decision support tool for people with malignant pleural effusion. BMC Med Inf Decis Mak. 2020. https://doi.org/10.1186/s12911-020-01200-3

Kearns Á, Kelly H, Pitt I. Rating experience of ICT-delivered aphasia rehabilitation: co-design of a feedback questionnaire. Aphasiology. 2020. https://doi.org/10.1080/02687038.2019.1649913

Kelemen M, Surman E, Dikomitis L. Cultural animation in health research: an innovative methodology for patient and public involvement and engagement. Health Expect. 2018. https://doi.org/10.1111/hex.12677

Keogh F, Carney P, O’Shea E. Innovative methods for involving people with dementia and carers in the policymaking process. Health Expect. 2021. https://doi.org/10.1111/hex.13213

Micsinszki SK, Buettgen A, Mulvale G, Moll S, Wyndham-West M, Bruce E, Rogerson K, Murray-Leung L, Fleisig R, Park S, Phoenix M. Creative processes in co-designing a co-design hub: towards system change in health and social services in collaboration with structurally vulnerable populations. Evid Policy. 2022. https://doi.org/10.1332/174426421X16366319768599

Valaitis R, Longaphy J, Ploeg J, Agarwal G, Oliver D, Nair K, Kastner M, Avilla E, Dolovich L. Health TAPESTRY: co-designing interprofessional primary care programs for older adults using the persona-scenario method. BMC Fam Pract. 2019. https://doi.org/10.1186/s12875-019-1013-9

Webber R, Partridge R, Grindell C. The creative co-design of low back pain education resources. Evid Policy. 2022. https://doi.org/10.1332/174426421X16437342906266

National Institute for Health and Care Research. A Researcher’s Guide to Patient and Public Involvement. https://oxfordbrc.nihr.ac.uk/wp-content/uploads/2017/03/A-Researchers-Guide-to-PPI.pdf Accessed 01 Nov 2023.

Selman L, Clement C, Douglas M, Douglas K, Taylor J, Metcalfe C, Lane J, Horwood J. Patient and public involvement in randomised clinical trials: a mixed-methods study of a clinical trials unit to identify good practice, barriers and facilitators. Trials. 2021 https://doi.org/10.1186/s13063-021-05701-y

Coulman K, Nicholson A, Shaw A, Daykin A, Selman L, Macefield R, Shorter G, Cramer H, Sydes M, Gamble C, Pick M, Taylor G, Lane J. Understanding and optimising patient and public involvement in trial oversight: an ethnographic study of eight clinical trials. Trials. 2020. https://doi.org/10.1186/s13063-020-04495-9

Ocloo J, Garfield S, Franklin B, Dawson S. Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a systematic review of reviews. Health Res Policy Sys. 2021. https://doi.org/10.1186/s12961-020-00644-3

National Institute for Health and Care Research. Briefing notes for researchers - public involvement in NHS, health and social care research. https://www.nihr.ac.uk/documents/briefing-notes-for-researchers-public-involvement-in-nhs-health-and-social-care-research/27371 Accessed 01 Nov 2023.

Download references

Acknowledgements

With thanks to the PHIRST-LIGHT public advisory group and consortium for their thoughts and contributions to the design of this work.

The research team is supported by a National Institute for Health and Care Research grant (PHIRST-LIGHT Reference NIHR 135190).

Author information

Olivia R. Phillips and Cerian Harries share joint first authorship.

Authors and Affiliations

Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK

Olivia R. Phillips, Jo Leonardi-Bee, Holly Knight & Joanne R. Morling

National Institute for Health and Care Research (NIHR) PHIRST-LIGHT, Nottingham, UK

Olivia R. Phillips, Cerian Harries, Jo Leonardi-Bee, Holly Knight, Lauren B. Sherar, Veronica Varela-Mato & Joanne R. Morling

School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK

Cerian Harries, Lauren B. Sherar & Veronica Varela-Mato

Nottingham Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK

Jo Leonardi-Bee

NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, NG7 2UH, UK

Joanne R. Morling

You can also search for this author in PubMed   Google Scholar

Contributions

Author contributions: study design: ORP, CH, JRM, JLB, HK, LBS, VVM, literature searching and screening: ORP, CH, JRM, data curation: ORP, CH, analysis: ORP, CH, JRM, manuscript draft: ORP, CH, JRM, Plain English Summary: ORP, manuscript critical review and editing: ORP, CH, JRM, JLB, HK, LBS, VVM.

Corresponding author

Correspondence to Olivia R. Phillips .

Ethics declarations

Ethics approval and consent to participate.

The Ethics Committee of the Faculty of Medicine and Health Sciences, University of Nottingham advised that approval from the ethics committee and consent to participate was not required for systematic review studies.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

40900_2024_580_MOESM1_ESM.docx

Additional file 1: Search strings: Description of data: the search strings and filters used in each of the 5 databases in this review

Additional file 2: Quality appraisal questions: Description of data: CASP quality appraisal questions

40900_2024_580_moesm3_esm.docx.

Additional file 3: Table 1: Description of data: elements of the data extraction table that are not in the main manuscript

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Phillips, O.R., Harries, C., Leonardi-Bee, J. et al. What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review. Res Involv Engagem 10 , 48 (2024). https://doi.org/10.1186/s40900-024-00580-4

Download citation

Received : 28 November 2023

Accepted : 25 April 2024

Published : 13 May 2024

DOI : https://doi.org/10.1186/s40900-024-00580-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Public and patient involvement
• Creative PPI
• Qualitative systematic review

Research Involvement and Engagement

ISSN: 2056-7529

• General enquiries: [email protected]

Artificial intelligence in strategy

Can machines automate strategy development? The short answer is no. However, there are numerous aspects of strategists’ work where AI and advanced analytics tools can already bring enormous value. Yuval Atsmon is a senior partner who leads the new McKinsey Center for Strategy Innovation, which studies ways new technologies can augment the timeless principles of strategy. In this episode of the Inside the Strategy Room podcast, he explains how artificial intelligence is already transforming strategy and what’s on the horizon. This is an edited transcript of the discussion. For more conversations on the strategy issues that matter, follow the series on your preferred podcast platform .

Joanna Pachner: What does artificial intelligence mean in the context of strategy?

Yuval Atsmon: When people talk about artificial intelligence, they include everything to do with analytics, automation, and data analysis. Marvin Minsky, the pioneer of artificial intelligence research in the 1960s, talked about AI as a “suitcase word”—a term into which you can stuff whatever you want—and that still seems to be the case. We are comfortable with that because we think companies should use all the capabilities of more traditional analysis while increasing automation in strategy that can free up management or analyst time and, gradually, introducing tools that can augment human thinking.

Joanna Pachner: AI has been embraced by many business functions, but strategy seems to be largely immune to its charms. Why do you think that is?

Subscribe to the Inside the Strategy Room podcast

Yuval Atsmon: You’re right about the limited adoption. Only 7 percent of respondents to our survey about the use of AI say they use it in strategy or even financial planning, whereas in areas like marketing, supply chain, and service operations, it’s 25 or 30 percent. One reason adoption is lagging is that strategy is one of the most integrative conceptual practices. When executives think about strategy automation, many are looking too far ahead—at AI capabilities that would decide, in place of the business leader, what the right strategy is. They are missing opportunities to use AI in the building blocks of strategy that could significantly improve outcomes.

I like to use the analogy to virtual assistants. Many of us use Alexa or Siri but very few people use these tools to do more than dictate a text message or shut off the lights. We don’t feel comfortable with the technology’s ability to understand the context in more sophisticated applications. AI in strategy is similar: it’s hard for AI to know everything an executive knows, but it can help executives with certain tasks.

When executives think about strategy automation, many are looking too far ahead—at AI deciding the right strategy. They are missing opportunities to use AI in the building blocks of strategy.

Joanna Pachner: What kind of tasks can AI help strategists execute today?

Yuval Atsmon: We talk about six stages of AI development. The earliest is simple analytics, which we refer to as descriptive intelligence. Companies use dashboards for competitive analysis or to study performance in different parts of the business that are automatically updated. Some have interactive capabilities for refinement and testing.

The second level is diagnostic intelligence, which is the ability to look backward at the business and understand root causes and drivers of performance. The level after that is predictive intelligence: being able to anticipate certain scenarios or options and the value of things in the future based on momentum from the past as well as signals picked in the market. Both diagnostics and prediction are areas that AI can greatly improve today. The tools can augment executives’ analysis and become areas where you develop capabilities. For example, on diagnostic intelligence, you can organize your portfolio into segments to understand granularly where performance is coming from and do it in a much more continuous way than analysts could. You can try 20 different ways in an hour versus deploying one hundred analysts to tackle the problem.

Predictive AI is both more difficult and more risky. Executives shouldn’t fully rely on predictive AI, but it provides another systematic viewpoint in the room. Because strategic decisions have significant consequences, a key consideration is to use AI transparently in the sense of understanding why it is making a certain prediction and what extrapolations it is making from which information. You can then assess if you trust the prediction or not. You can even use AI to track the evolution of the assumptions for that prediction.

Those are the levels available today. The next three levels will take time to develop. There are some early examples of AI advising actions for executives’ consideration that would be value-creating based on the analysis. From there, you go to delegating certain decision authority to AI, with constraints and supervision. Eventually, there is the point where fully autonomous AI analyzes and decides with no human interaction.

Because strategic decisions have significant consequences, you need to understand why AI is making a certain prediction and what extrapolations it’s making from which information.

Joanna Pachner: What kind of businesses or industries could gain the greatest benefits from embracing AI at its current level of sophistication?

Yuval Atsmon: Every business probably has some opportunity to use AI more than it does today. The first thing to look at is the availability of data. Do you have performance data that can be organized in a systematic way? Companies that have deep data on their portfolios down to business line, SKU, inventory, and raw ingredients have the biggest opportunities to use machines to gain granular insights that humans could not.

Companies whose strategies rely on a few big decisions with limited data would get less from AI. Likewise, those facing a lot of volatility and vulnerability to external events would benefit less than companies with controlled and systematic portfolios, although they could deploy AI to better predict those external events and identify what they can and cannot control.

Third, the velocity of decisions matters. Most companies develop strategies every three to five years, which then become annual budgets. If you think about strategy in that way, the role of AI is relatively limited other than potentially accelerating analyses that are inputs into the strategy. However, some companies regularly revisit big decisions they made based on assumptions about the world that may have since changed, affecting the projected ROI of initiatives. Such shifts would affect how you deploy talent and executive time, how you spend money and focus sales efforts, and AI can be valuable in guiding that. The value of AI is even bigger when you can make decisions close to the time of deploying resources, because AI can signal that your previous assumptions have changed from when you made your plan.

Joanna Pachner: Can you provide any examples of companies employing AI to address specific strategic challenges?

Yuval Atsmon: Some of the most innovative users of AI, not coincidentally, are AI- and digital-native companies. Some of these companies have seen massive benefits from AI and have increased its usage in other areas of the business. One mobility player adjusts its financial planning based on pricing patterns it observes in the market. Its business has relatively high flexibility to demand but less so to supply, so the company uses AI to continuously signal back when pricing dynamics are trending in a way that would affect profitability or where demand is rising. This allows the company to quickly react to create more capacity because its profitability is highly sensitive to keeping demand and supply in equilibrium.

Joanna Pachner: Given how quickly things change today, doesn’t AI seem to be more a tactical than a strategic tool, providing time-sensitive input on isolated elements of strategy?

Yuval Atsmon: It’s interesting that you make the distinction between strategic and tactical. Of course, every decision can be broken down into smaller ones, and where AI can be affordably used in strategy today is for building blocks of the strategy. It might feel tactical, but it can make a massive difference. One of the world’s leading investment firms, for example, has started to use AI to scan for certain patterns rather than scanning individual companies directly. AI looks for consumer mobile usage that suggests a company’s technology is catching on quickly, giving the firm an opportunity to invest in that company before others do. That created a significant strategic edge for them, even though the tool itself may be relatively tactical.

Joanna Pachner: McKinsey has written a lot about cognitive biases  and social dynamics that can skew decision making. Can AI help with these challenges?

Yuval Atsmon: When we talk to executives about using AI in strategy development, the first reaction we get is, “Those are really big decisions; what if AI gets them wrong?” The first answer is that humans also get them wrong—a lot. [Amos] Tversky, [Daniel] Kahneman, and others have proven that some of those errors are systemic, observable, and predictable. The first thing AI can do is spot situations likely to give rise to biases. For example, imagine that AI is listening in on a strategy session where the CEO proposes something and everyone says “Aye” without debate and discussion. AI could inform the room, “We might have a sunflower bias here,” which could trigger more conversation and remind the CEO that it’s in their own interest to encourage some devil’s advocacy.

We also often see confirmation bias, where people focus their analysis on proving the wisdom of what they already want to do, as opposed to looking for a fact-based reality. Just having AI perform a default analysis that doesn’t aim to satisfy the boss is useful, and the team can then try to understand why that is different than the management hypothesis, triggering a much richer debate.

In terms of social dynamics, agency problems can create conflicts of interest. Every business unit [BU] leader thinks that their BU should get the most resources and will deliver the most value, or at least they feel they should advocate for their business. AI provides a neutral way based on systematic data to manage those debates. It’s also useful for executives with decision authority, since we all know that short-term pressures and the need to make the quarterly and annual numbers lead people to make different decisions on the 31st of December than they do on January 1st or October 1st. Like the story of Ulysses and the sirens, you can use AI to remind you that you wanted something different three months earlier. The CEO still decides; AI can just provide that extra nudge.

Joanna Pachner: It’s like you have Spock next to you, who is dispassionate and purely analytical.

Yuval Atsmon: That is not a bad analogy—for Star Trek fans anyway.

Joanna Pachner: Do you have a favorite application of AI in strategy?

Yuval Atsmon: I have worked a lot on resource allocation, and one of the challenges, which we call the hockey stick phenomenon, is that executives are always overly optimistic about what will happen. They know that resource allocation will inevitably be defined by what you believe about the future, not necessarily by past performance. AI can provide an objective prediction of performance starting from a default momentum case: based on everything that happened in the past and some indicators about the future, what is the forecast of performance if we do nothing? This is before we say, “But I will hire these people and develop this new product and improve my marketing”— things that every executive thinks will help them overdeliver relative to the past. The neutral momentum case, which AI can calculate in a cold, Spock-like manner, can change the dynamics of the resource allocation discussion. It’s a form of predictive intelligence accessible today and while it’s not meant to be definitive, it provides a basis for better decisions.

Joanna Pachner: Do you see access to technology talent as one of the obstacles to the adoption of AI in strategy, especially at large companies?

Yuval Atsmon: I would make a distinction. If you mean machine-learning and data science talent or software engineers who build the digital tools, they are definitely not easy to get. However, companies can increasingly use platforms that provide access to AI tools and require less from individual companies. Also, this domain of strategy is exciting—it’s cutting-edge, so it’s probably easier to get technology talent for that than it might be for manufacturing work.

The bigger challenge, ironically, is finding strategists or people with business expertise to contribute to the effort. You will not solve strategy problems with AI without the involvement of people who understand the customer experience and what you are trying to achieve. Those who know best, like senior executives, don’t have time to be product managers for the AI team. An even bigger constraint is that, in some cases, you are asking people to get involved in an initiative that may make their jobs less important. There could be plenty of opportunities for incorpo­rating AI into existing jobs, but it’s something companies need to reflect on. The best approach may be to create a digital factory where a different team tests and builds AI applications, with oversight from senior stakeholders.

The big challenge is finding strategists to contribute to the AI effort. You are asking people to get involved in an initiative that may make their jobs less important.

Joanna Pachner: Do you think this worry about job security and the potential that AI will automate strategy is realistic?

Yuval Atsmon: The question of whether AI will replace human judgment and put humanity out of its job is a big one that I would leave for other experts.

The pertinent question is shorter-term automation. Because of its complexity, strategy would be one of the later domains to be affected by automation, but we are seeing it in many other domains. However, the trend for more than two hundred years has been that automation creates new jobs, although ones requiring different skills. That doesn’t take away the fear some people have of a machine exposing their mistakes or doing their job better than they do it.

Joanna Pachner: We recently published an article about strategic courage in an age of volatility  that talked about three types of edge business leaders need to develop. One of them is an edge in insights. Do you think AI has a role to play in furnishing a proprietary insight edge?

Yuval Atsmon: One of the challenges most strategists face is the overwhelming complexity of the world we operate in—the number of unknowns, the information overload. At one level, it may seem that AI will provide another layer of complexity. In reality, it can be a sharp knife that cuts through some of the clutter. The question to ask is, Can AI simplify my life by giving me sharper, more timely insights more easily?

Joanna Pachner: You have been working in strategy for a long time. What sparked your interest in exploring this intersection of strategy and new technology?

Yuval Atsmon: I have always been intrigued by things at the boundaries of what seems possible. Science fiction writer Arthur C. Clarke’s second law is that to discover the limits of the possible, you have to venture a little past them into the impossible, and I find that particularly alluring in this arena.

AI in strategy is in very nascent stages but could be very consequential for companies and for the profession. For a top executive, strategic decisions are the biggest way to influence the business, other than maybe building the top team, and it is amazing how little technology is leveraged in that process today. It’s conceivable that competitive advantage will increasingly rest in having executives who know how to apply AI well. In some domains, like investment, that is already happening, and the difference in returns can be staggering. I find helping companies be part of that evolution very exciting.

Explore a career with us

Related articles.

Strategic courage in an age of volatility

Bias Busters Collection

Along with Stanford news and stories, show me:

• Student information
• Faculty/Staff information

We want to provide announcements, events, leadership messages and resources that are relevant to you. Your selection is stored in a browser cookie which you can remove at any time using “Clear all personalization” below.

Image credit: Claire Scully

New advances in technology are upending education, from the recent debut of new artificial intelligence (AI) chatbots like ChatGPT to the growing accessibility of virtual-reality tools that expand the boundaries of the classroom. For educators, at the heart of it all is the hope that every learner gets an equal chance to develop the skills they need to succeed. But that promise is not without its pitfalls.

“Technology is a game-changer for education – it offers the prospect of universal access to high-quality learning experiences, and it creates fundamentally new ways of teaching,” said Dan Schwartz, dean of Stanford Graduate School of Education (GSE), who is also a professor of educational technology at the GSE and faculty director of the Stanford Accelerator for Learning . “But there are a lot of ways we teach that aren’t great, and a big fear with AI in particular is that we just get more efficient at teaching badly. This is a moment to pay attention, to do things differently.”

For K-12 schools, this year also marks the end of the Elementary and Secondary School Emergency Relief (ESSER) funding program, which has provided pandemic recovery funds that many districts used to invest in educational software and systems. With these funds running out in September 2024, schools are trying to determine their best use of technology as they face the prospect of diminishing resources.

Here, Schwartz and other Stanford education scholars weigh in on some of the technology trends taking center stage in the classroom this year.

AI in the classroom

In 2023, the big story in technology and education was generative AI, following the introduction of ChatGPT and other chatbots that produce text seemingly written by a human in response to a question or prompt. Educators immediately worried that students would use the chatbot to cheat by trying to pass its writing off as their own. As schools move to adopt policies around students’ use of the tool, many are also beginning to explore potential opportunities – for example, to generate reading assignments or coach students during the writing process.

AI can also help automate tasks like grading and lesson planning, freeing teachers to do the human work that drew them into the profession in the first place, said Victor Lee, an associate professor at the GSE and faculty lead for the AI + Education initiative at the Stanford Accelerator for Learning. “I’m heartened to see some movement toward creating AI tools that make teachers’ lives better – not to replace them, but to give them the time to do the work that only teachers are able to do,” he said. “I hope to see more on that front.”

He also emphasized the need to teach students now to begin questioning and critiquing the development and use of AI. “AI is not going away,” said Lee, who is also director of CRAFT (Classroom-Ready Resources about AI for Teaching), which provides free resources to help teach AI literacy to high school students across subject areas. “We need to teach students how to understand and think critically about this technology.”

Immersive environments

The use of immersive technologies like augmented reality, virtual reality, and mixed reality is also expected to surge in the classroom, especially as new high-profile devices integrating these realities hit the marketplace in 2024.

The educational possibilities now go beyond putting on a headset and experiencing life in a distant location. With new technologies, students can create their own local interactive 360-degree scenarios, using just a cell phone or inexpensive camera and simple online tools.

“This is an area that’s really going to explode over the next couple of years,” said Kristen Pilner Blair, director of research for the Digital Learning initiative at the Stanford Accelerator for Learning, which runs a program exploring the use of virtual field trips to promote learning. “Students can learn about the effects of climate change, say, by virtually experiencing the impact on a particular environment. But they can also become creators, documenting and sharing immersive media that shows the effects where they live.”

Integrating AI into virtual simulations could also soon take the experience to another level, Schwartz said. “If your VR experience brings me to a redwood tree, you could have a window pop up that allows me to ask questions about the tree, and AI can deliver the answers.”

Gamification

Another trend expected to intensify this year is the gamification of learning activities, often featuring dynamic videos with interactive elements to engage and hold students’ attention.

“Gamification is a good motivator, because one key aspect is reward, which is very powerful,” said Schwartz. The downside? Rewards are specific to the activity at hand, which may not extend to learning more generally. “If I get rewarded for doing math in a space-age video game, it doesn’t mean I’m going to be motivated to do math anywhere else.”

Gamification sometimes tries to make “chocolate-covered broccoli,” Schwartz said, by adding art and rewards to make speeded response tasks involving single-answer, factual questions more fun. He hopes to see more creative play patterns that give students points for rethinking an approach or adapting their strategy, rather than only rewarding them for quickly producing a correct response.

Data-gathering and analysis

The growing use of technology in schools is producing massive amounts of data on students’ activities in the classroom and online. “We’re now able to capture moment-to-moment data, every keystroke a kid makes,” said Schwartz – data that can reveal areas of struggle and different learning opportunities, from solving a math problem to approaching a writing assignment.

But outside of research settings, he said, that type of granular data – now owned by tech companies – is more likely used to refine the design of the software than to provide teachers with actionable information.

The promise of personalized learning is being able to generate content aligned with students’ interests and skill levels, and making lessons more accessible for multilingual learners and students with disabilities. Realizing that promise requires that educators can make sense of the data that’s being collected, said Schwartz – and while advances in AI are making it easier to identify patterns and findings, the data also needs to be in a system and form educators can access and analyze for decision-making. Developing a usable infrastructure for that data, Schwartz said, is an important next step.

With the accumulation of student data comes privacy concerns: How is the data being collected? Are there regulations or guidelines around its use in decision-making? What steps are being taken to prevent unauthorized access? In 2023 K-12 schools experienced a rise in cyberattacks, underscoring the need to implement strong systems to safeguard student data.

Technology is “requiring people to check their assumptions about education,” said Schwartz, noting that AI in particular is very efficient at replicating biases and automating the way things have been done in the past, including poor models of instruction. “But it’s also opening up new possibilities for students producing material, and for being able to identify children who are not average so we can customize toward them. It’s an opportunity to think of entirely new ways of teaching – this is the path I hope to see.”

• Open access
• Published: 13 May 2024

Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes

• Léa Solh Dost   ORCID: orcid.org/0000-0001-5767-1305 1 , 2 ,
• Giacomo Gastaldi   ORCID: orcid.org/0000-0001-6327-7451 3 &
• Marie P. Schneider   ORCID: orcid.org/0000-0002-7557-9278 1 , 2  

BMC Health Services Research volume  24 , Article number:  620 ( 2024 ) Cite this article

131 Accesses

Metrics details

Continuity of care is under great pressure during the transition from hospital to outpatient care. Medication changes during hospitalization may be poorly communicated and understood, compromising patient safety during the transition from hospital to home. The main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients’ perspectives of their medications from hospital to two months after discharge.

Patients with type 2 diabetes, with at least two comorbidities and who returned home after discharge, were recruited during their hospitalization. A descriptive qualitative longitudinal research approach was adopted, with four in-depth semi-structured interviews per participant over a period of two months after discharge. Interviews were based on semi-structured guides, transcribed verbatim, and a thematic analysis was conducted.

Twenty-one participants were included from October 2020 to July 2021. Seventy-five interviews were conducted. Three main themes were identified: (A) Medication management, (B) Medication understanding, and (C) Medication adherence, during three periods: (1) Hospitalization, (2) Care transition, and (3) Outpatient care. Participants had varying levels of need for medication information and involvement in medication management during hospitalization and in outpatient care. The transition from hospital to autonomous medication management was difficult for most participants, who quickly returned to their routines with some participants experiencing difficulties in medication adherence.

Conclusions

The transition from hospital to outpatient care is a challenging process during which discharged patients are vulnerable and are willing to take steps to better manage, understand, and adhere to their medications. The resulting tension between patients’ difficulties with their medications and lack of standardized healthcare support calls for interprofessional guidelines to better address patients’ needs, increase their safety, and standardize physicians’, pharmacists’, and nurses’ roles and responsibilities.

Peer Review reports

Introduction

Continuity of patient care is characterized as the collaborative engagement between the patient and their physician-led care team in the ongoing management of healthcare, with the mutual objective of delivering high-quality and cost-effective medical care [ 1 ]. Continuity of care is under great pressure during the transition of care from hospital to outpatient care, with a risk of compromising patients’ safety [ 2 , 3 ]. The early post-discharge period is a high-risk and fragile transition: once discharged, one in five patients experience at least one adverse event during the first three weeks following discharge, and more than half of these adverse events are drug-related [ 4 , 5 ]. A retrospective study examining all discharged patients showed that adverse drug events (ADEs) account for up to 20% of 30-day hospital emergency readmissions [ 6 ]. During hospitalization, patients’ medications are generally modified, with an average of nearly four medication changes per patient [ 7 ]. Information regarding medications such as medication changes, the expected effect, side effects, and instructions for use are frequently poorly communicated to patients during hospitalization and at discharge [ 8 , 9 , 10 , 11 ]. Between 20 and 60% of discharged patients lack knowledge of their medications [ 12 , 13 ]. Consideration of patients’ needs and their active engagement in decision-making during hospitalization regarding their medications are often lacking [ 11 , 14 , 15 ]. This can lead to unsafe discharge and contribute to medication adherence difficulties, such as non-implementation of newly prescribed medications [ 16 , 17 ].

Patients with multiple comorbidities and polypharmacy are at higher risk of ADE [ 18 ]. Type 2 diabetes is one of the chronic health conditions most frequently associated with comorbidities and patients with type 2 diabetes often lack care continuum [ 19 , 20 , 21 ]. The prevalence of patients hospitalized with type 2 diabetes can exceed 40% [ 22 ] and these patients are at higher risk for readmission due to their comorbidities and their medications, such as insulin and oral hypoglycemic agents [ 23 , 24 , 25 ].

Interventions and strategies to improve patient care and safety at transition have shown mixed results worldwide in reducing cost, rehospitalization, ADE, and non-adherence [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. However, interventions that are patient-centered, with a patient follow-up and led by interprofessional healthcare teams showed promising results [ 34 , 35 , 36 ]. Most of these interventions have not been implemented routinely due to the extensive time to translate research into practice and the lack of hybrid implementation studies [ 37 , 38 , 39 , 40 , 41 ]. In addition, patient-reported outcomes and perspectives have rarely been considered, yet patients’ involvement is essential for seamless and integrated care [ 42 , 43 ]. Interprofessional collaboration in which patients are full members of the interprofessional team, is still in its infancy in outpatient care [ 44 ]. Barriers and facilitators regarding medications at the transition of care have been explored in multiple qualitative studies at one given time in a given setting (e.g., at discharge, one-month post-discharge) [ 8 , 45 , 46 , 47 , 48 ]. However, few studies have adopted a holistic methodology from the hospital to the outpatient setting to explore changes in patients’ perspectives over time [ 49 , 50 , 51 ]. Finally, little is known about whether, how, and when patients return to their daily routine following hospitalization and the impact of hospitalization weeks after discharge.

In Switzerland, continuity of care after hospital discharge is still poorly documented, both in terms of contextual analysis and interventional studies, and is mainly conducted in the hospital setting [ 31 , 35 , 52 , 53 , 54 , 55 , 56 ]. The first step of an implementation science approach is to perform a contextual analysis to set up effective interventions adapted to patients’ needs and aligned to healthcare professionals’ activities in a specific context [ 41 , 57 ]. Therefore, the main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and on their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients’ perspectives of their medications from hospital to two months after discharge.

Study design

This qualitative longitudinal study, conducted from October 2020 to July 2021, used a qualitative descriptive methodology through four consecutive in-depth semi-structured interviews per participant at three, 10-, 30- and 60-days post-discharge, as illustrated in Fig.  1 . Longitudinal qualitative research is characterized by qualitative data collection at different points in time and focuses on temporality, such as time and change [ 58 , 59 ]. Qualitative descriptive studies aim to explore and describe the depth and complexity of human experiences or phenomena [ 60 , 61 , 62 ]. We focused our qualitative study on the 60 first days after discharge as this period is considered highly vulnerable and because studies often use 30- or 60-days readmission as an outcome measure [ 5 , 63 ].

This qualitative study follows the Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethics committee approval was sought and granted by the Cantonal Research Ethics Commission, Geneva (CCER) (2020 − 01779).

Recruitment took place during participants’ hospitalization in the general internal medicine divisions at the Geneva University Hospitals in the canton of Geneva (500 000 inhabitants), Switzerland. Interviews took place at participants’ homes, in a private office at the University of Geneva, by telephone or by secure video call, according to participants’ preference. Informal caregivers could also participate alongside the participants.

Study flowchart

Researcher characteristics

All the researchers were trained in qualitative studies. The diabetologist and researcher (GG) who enrolled the patients in the study was involved directly or indirectly (advice asked to the Geneva University Hospital diabetes team of which he was a part) for most participants’ care during hospitalization. LS (Ph.D. student and community pharmacist) was unknown to participants and presented herself during hospitalization as a “researcher” and not as a healthcare professional to avoid any risk of influencing participants’ answers. This study was not interventional, and the interviewer (LS) invited participants to contact a healthcare professional for any questions related to their medication or medical issues.

Population and sampling strategy

Patients with type 2 diabetes were chosen as an example population to describe polypharmacy patients as these patients usually have several health issues and polypharmacy [ 20 , 22 , 25 ]. Inclusions criteria for the study were: adult patients with type 2 diabetes, with at least two other comorbidities, hospitalized for at least three days in a general internal medicine ward, with a minimum of one medication change during hospital stay, and who self-managed their medications once discharged home. Exclusion criteria were patients not reachable by telephone following discharge, unable to give consent (patients with schizophrenia, dementia, brain damage, or drug/alcohol misuse), and who could not communicate in French. A purposive sampling methodology was applied aiming to include participants with different ages, genders, types, and numbers of health conditions by listing participants’ characteristics in a double-entry table, available in Supplementary Material 1 , until thematic saturation was reached. Thematic saturation was considered achieved when no new code or theme emerged and new data repeated previously coded information [ 64 ]. The participants were identified if they were hospitalized in the ward dedicated to diabetes care or when the diabetes team was contacted for advice. The senior ward physician (GG) screened eligible patients and the interviewer (LS) obtained written consent before hospital discharge.

Data collection and instruments

Sociodemographic (age, gender, educational level, living arrangement) and clinical characteristics (reason for hospitalization, date of admission, health conditions, diabetes diagnosis, medications before and during hospitalization) were collected by interviewing participants before their discharge and by extracting participants’ data from electronic hospital files by GG and LS. Participants’ pharmacies were contacted with the participant’s consent to obtain medication records from the last three months if information regarding medications before hospitalization was missing in the hospital files.

Semi-structured interview guides for each interview (at three, 10-, 30- and 60-days post-discharge) were developed based on different theories and components of health behavior and medication adherence: the World Health Organization’s (WHO) five dimensions for adherence, the Information-Motivation-Behavioral skills model and the Social Cognitive Theory [ 65 , 66 , 67 ]. Each interview explored participants’ itinerary in the healthcare system and their perspectives on their medications. Regarding medications, the following themes were mentioned at each interview: changes in medications, patients’ understanding and implication; information on their medications, self-management of their medications, and patients’ medication adherence. Other aspects were mentioned in specific interviews: patients’ hospitalization and experience on their return home (interview 1), motivation (interviews 2 and 4), and patient’s feedback on the past two months (interview 4). Interview guides translated from French are available in Supplementary Material 2 . The participants completed self-reported and self-administrated questionnaires at different interviews to obtain descriptive information on different factors that may affect medication management and adherence: self-report questionnaires on quality of life (EQ-5D-5 L) [ 68 ], literacy (Schooling-Opinion-Support questionnaire) [ 69 ], medication adherence (Adherence Visual Analogue Scale, A-VAS) [ 70 ] and Belief in Medication Questionnaire (BMQ) [ 71 ] were administered to each participant at the end of selected interviews to address the different factors that may affect medication management and adherence as well as to determine a trend of determinants over time. The BMQ contains two subscores: Specific-Necessity and Specific-Concerns, addressing respectively their perceived needs for their medications, and their concerns about adverse consequences associated with taking their medication [ 72 ].

Data management

Informed consent forms, including consent to obtain health data, were securely stored in a private office at the University of Geneva. The participants’ identification key was protected by a password known only by MS and LS. Confidentiality was guaranteed by pseudonymization of participants’ information and audio-recordings were destroyed once analyzed. Sociodemographic and clinical characteristics, medication changes, and answers to questionnaires were securely collected by electronic case report forms (eCRFs) on RedCap®. Interviews were double audio-recorded and field notes were taken during interviews. Recorded interviews were manually transcribed verbatim in MAXQDA® (2018.2) by research assistants and LS and transcripts were validated for accuracy by LS. A random sample of 20% of questionnaires was checked for accuracy for the transcription from the paper questionnaires to the eCRFs. Recorded sequences with no link to the discussed topics were not transcribed and this was noted in the transcripts.

Data analysis

A descriptive statistical analysis of sociodemographic, clinical characteristics and self-reported questionnaire data was carried out. A thematic analysis of transcripts was performed, as described by Braun and Clarke [ 73 ], by following six steps: raw data was read, text segments related to the study objectives were identified, text segments to create new categories were identified, similar or redundant categories were reduced and a model that integrated all significant categories was created. The analysis was conducted in parallel with patient enrolment to ensure data saturation. To ensure the validity of the coding method, transcripts were double coded independently and discussed by the research team until similar themes were obtained. The research group developed and validated an analysis grid, with which LS coded systematically the transcriptions and met regularly with the research team to discuss questions on data analysis and to ensure the quality of coding. The analysis was carried out in French, and the verbatims of interest cited in the manuscript were translated and validated by a native English-speaking researcher to preserve the meaning.

In this analysis, we used the term “healthcare professionals” when more than one profession could be involved in participants’ medication management. Otherwise, when a specific healthcare professional was involved, we used the designated profession (e.g. physicians, pharmacists).

Patient and public involvement

During the development phase of the study, interview guides and questionnaires were reviewed for clarity and validity and adapted by two patient partners, with multiple health conditions and who experienced previously a hospital discharge. They are part of the HUG Patients Partners + 3P platform for research and patient and public involvement.

Interviews and participants’ descriptions

A total of 75 interviews were conducted with 21 participants. In total, 31 patients were contacted, seven refused to participate (four at the project presentation and three at consent), two did not enter the selection criteria at discharge and one was unreachable after discharge. Among the 21 participants, 15 participated in all interviews, four in three interviews, one in two interviews, and one in one interview, due to scheduling constraints. Details regarding interviews and participants characteristics are presented in Tables  1 and 2 .

The median length of time between hospital discharge and interviews 1,2,3 and 4 was 5 (IQR: 4–7), 14 (13-20), 35 (22-38), and 63 days (61-68), respectively. On average, by comparing medications at hospital admission and discharge, a median of 7 medication changes (IQR: 6–9, range:2;17) occurred per participant during hospitalization and a median of 7 changes (5–12) during the two months following discharge. Details regarding participants’ medications are described in Table  3 .

Patient self-reported adherence over the past week for their three most challenging medications are available in Supplementary Material 3 .

Qualitative analysis

We defined care transition as the period from discharge until the first medical appointment post-discharge, and outpatient care as the period starting after the first medical appointment. Data was organized into three key themes (A. Medication management, B. Medication understanding, and C. Medication adherence) divided into subthemes at three time points (1. Hospitalization, 2. Care transition and 3. Outpatient care). Figure  2 summarizes and illustrates the themes and subthemes with their influencing factors as bullet points.

Participants’ medication management, understanding and adherence during hospitalization, care transition and outpatient care

A. Medication management

A.1 medication management during hospitalization: medication management by hospital staff.

Medications during hospitalization were mainly managed by hospital healthcare professionals (i.e. nurses and physicians) with varying degrees of patient involvement: “At the hospital, they prepared the medications for me. […] I didn’t even know what the packages looked like.” Participant 22; interview 1 (P22.1) Some participants reported having therapeutic education sessions with specialized nurses and physicians, such as the explanation and demonstration of insulin injection and glucose monitoring. A patient reported that he was given the choice of several treatments and was involved in shared decision-making. Other participants had an active role in managing and optimizing dosages, such as rapid insulin, due to prior knowledge and use of medications before hospitalization.

A.2 Medication management at transition: obtaining the medication and initiating self-management

Once discharged, some participants had difficulties obtaining their medications at the pharmacy because some medications were not stored and had to be ordered, delaying medication initiation. To counter this problem upstream, a few participants were provided a 24-to-48-hour supply of medications at discharge. It was sometimes requested by the patient or suggested by the healthcare professionals but was not systematic. The transition from medication management by hospital staff to self-management was exhausting for most participants who were faced with a large amount of new information and changes in their medications: “ When I was in the hospital, I didn’t even realize all the changes. When I came back home, I took away the old medication packages and got out the new ones. And then I thought : « my God, all this…I didn’t know I had all these changes » ” P2.1 Written documentation, such as the discharge prescription or dosage labels on medication packages, was helpful in managing their medication at home. Most participants used weekly pill organizers to manage their medications, which were either already used before hospitalization or were introduced post-discharge. The help of a family caregiver in managing and obtaining medications was reported as a facilitator.

A.3 Medication management in outpatient care: daily self-management and medication burden

A couple of days or weeks after discharge, most participants had acquired a routine so that medication management was less demanding, but the medication burden varied depending on the participants. For some, medication management became a simple action well implemented in their routine (“It has become automatic” , P23.4), while for others, the number of medications and the fact that the medications reminded them of the disease was a heavy burden to bear on a daily basis (“ During the first few days after getting out of the hospital, I thought I was going to do everything right. In the end, well [laughs] it’s complicated. I ended up not always taking the medication, not monitoring the blood sugar” P12.2) To support medication self-management, some participants had written documentation such as treatment plans, medication lists, and pictures of their medication packages on their phones. Some participants had difficulties obtaining medications weeks after discharge as discharge prescriptions were not renewable and participants did not see their physician in time. Others had to visit multiple physicians to have their prescriptions updated. A few participants were faced with prescription or dispensing errors, such as prescribing or dispensing the wrong dosage, which affected medication management and decreased trust in healthcare professionals. In most cases, according to participants, the pharmacy staff worked in an interprofessional collaboration with physicians to provide new and updated prescriptions.

B. Medication understanding

B.1 medication understanding during hospitalization: new information and instructions.

The amount of information received during hospitalization varied considerably among participants with some reporting having received too much, while others saying they received too little information regarding medication changes, the reason for changes, or for introducing new medications: “They told me I had to take this medication all my life, but they didn’t tell me what the effects were or why I was taking it.” P5.3

Hospitalization was seen by some participants as a vulnerable and tiring period during which they were less receptive to information. Information and explanations were generally given verbally, making it complicated for most participants to recall it. Some participants reported that hospital staff was attentive to their needs for information and used communication techniques such as teach-back (a way of checking understanding by asking participants to say in their own words what they need to know or do about their health or medications). Some participants were willing to be proactive in the understanding of their medications while others were more passive, had no specific needs for information, and did not see how they could be engaged more.

B.2 Medication understanding at transition: facing medication changes

At hospital discharge, the most challenging difficulty for participants was to understand the changes made regarding their medications. For newly diagnosed participants, the addition of new medications was more difficult to understand, whereas, for experienced participants, changes in known medications such as dosage modification, changes within a therapeutic class, and generic substitutions were the most difficult to understand. Not having been informed about changes caused confusion and misunderstanding. Therefore, medication reconciliation done by the patient was time-consuming, especially for participants with multiple medications: “ They didn’t tell me at all that they had changed my treatment completely. They just told me : « We’ve changed a few things. But it was the whole treatment ». ” P2.3 Written information, such as the discharge prescription, the discharge report (brief letter summarizing information about the hospitalization, given to the patient at discharge), or the label on the medication box (written by the pharmacist with instructions on dosage) helped them find or recall information about their medications and diagnoses. However, technical terms were used in hospital documentations and were not always understandable. For example, this participant said: “ On the prescription of valsartan, they wrote: ‘resume in the morning once profile…’[once hypertension profile allows]… I don’t know what that means.” P8.1 In addition, some documents were incomplete, as mentioned by a patient who did not have the insulin dosage mentioned on the hospital prescription. Some participants sought help from healthcare professionals, such as pharmacists, hospital physicians, or general practitioners a few days after discharge to review medications, answer questions, or obtain additional information.

B.3 Medication understanding in the outpatient care: concerns and knowledge

Weeks after discharge, most participants had concerns about the long-term use of their medications, their usefulness, and the possible risk of interactions or side effects. Some participants also reported having some lack of knowledge regarding indications, names, or how the medication worked: “I don’t even know what Brilique® [ticagrelor, antiplatelet agent] is for. It’s for blood pressure, isn’t it?. I don’t know.” P11.4 According to participants, the main reasons for the lack of understanding were the lack of information at the time of prescribing and the large number of medications, making it difficult to search for information and remember it. Participants sought information from different healthcare professionals or by themselves, on package inserts, through the internet, or from family and friends. Others reported having had all the information needed or were not interested in having more information. In addition, participants with low medication literacy, such as non-native speakers or elderly people, struggled more with medication understanding and sought help from family caregivers or healthcare professionals, even weeks after discharge: “ I don’t understand French very well […] [The doctor] explained it very quickly…[…] I didn’t understand everything he was saying” P16.2

C. Medication adherence

C.2 medication adherence at transition: adopting new behaviors.

Medication adherence was not mentioned as a concern during hospitalization and a few participants reported difficulties in medication initiation once back home: “I have an injection of Lantus® [insulin] in the morning, but obviously, the first day [after discharge], I forgot to do it because I was not used to it.” P23.1 Participants had to quickly adopt new behaviors in the first few days after discharge, especially for participants with few medications pre-hospitalization. The use of weekly pill organizers, alarms and specific storage space were reported as facilitators to support adherence. One patient did not initiate one of his medications because he did not understand the medication indication, and another patient took her old medications because she was used to them. Moreover, most participants experienced their hospitalization as a turning point, a time when they focused on their health, thought about the importance of their medications, and discussed any new lifestyle or dietary measures that might be implemented.

C.3 Medication adherence in outpatient care: ongoing medication adherence

More medication adherence difficulties appeared a few weeks after hospital discharge when most participants reported nonadherence behaviors, such as difficulties implementing the dosage regimen, or intentionally discontinuing the medication and modifying the medication regimen on their initiative. Determinants positively influencing medication adherence were the establishment of a routine; organizing medications in weekly pill-organizers; organizing pocket doses (medications for a short period that participants take with them when away from home); seeking support from family caregivers; using alarm clocks; and using specific storage places. Reasons for nonadherence were changes in daily routine; intake times that were not convenient for the patient; the large number of medications; and poor knowledge of the medication or side effects. Healthcare professionals’ assistance for medication management, such as the help of home nurses or pharmacists for the preparation of weekly pill-organizers, was requested by participants or offered by healthcare professionals to support medication adherence: “ I needed [a home nurse] to put my pills in the pillbox. […] I felt really weak […] and I was making mistakes. So, I’m very happy [the doctor] offered me [home care]. […] I have so many medications.” P22.3 Some participants who experienced prehospitalization non-adherence were more aware of their non-adherence and implemented strategies, such as modifying the timing of intake: “I said to my doctor : « I forget one time out of two […], can I take them in the morning? » We looked it up and yes, I can take it in the morning.” P11.2 In contrast, some participants were still struggling with adherence difficulties that they had before hospitalization. Motivations for taking medications two months after discharge were to improve health, avoid complications, reduce symptoms, reduce the number of medications in the future or out of obligation: “ I force myself to take them because I want to get to the end of my diabetes, I want to reduce the number of pills as much as possible.” P14.2 After a few weeks post-hospitalization, for some participants, health and illness were no longer the priority because of other life imperatives (e.g., family or financial situation).

This longitudinal study provided a multi-faceted representation of how patients manage, understand, and adhere to their medications from hospital discharge to two months after discharge. Our findings highlighted the varying degree of participants’ involvement in managing their medications during their hospitalization, the individualized needs for information during and after hospitalization, the complicated transition from hospital to autonomous medication management, the adaptation of daily routines around medication once back home, and the adherence difficulties that surfaced in the outpatient care, with nonadherence prior to hospitalization being an indicator of the behavior after discharge. Finally, our results confirmed the lack of continuity in care and showed the lack of patient care standardization experienced by the participants during the transition from hospital to outpatient care.

This in-depth analysis of patients’ experiences reinforces common challenges identified in the existing literature such as the lack of personalized information [ 9 , 10 , 11 ], loss of autonomy during hospitalization [ 14 , 74 , 75 ], difficulties in obtaining medication at discharge [ 11 , 45 , 76 ] and challenges in understanding treatment modifications and generics substitution [ 11 , 32 , 77 , 78 ]. Some of these studies were conducted during patients’ hospitalization [ 10 , 75 , 79 ] or up to 12 months after discharge [ 80 , 81 ], but most studies focused on the few days following hospital discharge [ 9 , 11 , 14 , 82 ]. Qualitative studies on medications at transition often focused on a specific topic, such as medication information, or a specific moment in time, and often included healthcare professionals, which muted patients’ voices [ 9 , 10 , 11 , 47 , 49 ]. Our qualitative longitudinal methodology was interested in capturing the temporal dynamics, in-depth narratives, and contextual nuances of patients’ medication experiences during transitions of care [ 59 , 83 ]. This approach provided a comprehensive understanding of how patients’ perspectives and behaviors evolved over time, offering insights into the complex interactions of medication management, understanding and adherence, and turning points within their medication journeys. A qualitative longitudinal design was used by Fylan et al. to underline patients’ resilience in medication management during and after discharge, by Brandberg et al. to show the dynamic process of self-management during the 4 weeks post-discharge and by Lawton et al. to examine how patients with type 2 diabetes perceived their care after discharge over a period of four years [ 49 , 50 , 51 ]. Our study focused on the first two months following hospitalization and future studies should focus on following discharged and at-risk patients over a longer period, as “transitions of care do not comprise linear trajectories of patients’ movements, with a starting and finishing point. Instead, they are endless loops of movements” [ 47 ].

Our results provide a particularly thorough description of how participants move from a state of total dependency during hospitalization regarding their medication management to a sudden and complete autonomy after hospital discharge impacting medication management, understanding, and adherence in the first days after discharge for some participants. Several qualitative studies have described the lack of shared decision-making and the loss of patient autonomy during hospitalization, which had an impact on self-management and created conflicts with healthcare professionals [ 75 , 81 , 84 ]. Our study also highlights nuanced patient experiences, including varying levels of patient needs, involvement, and proactivity during hospitalization and outpatient care, and our results contribute to capturing different perspectives that contrast with some literature that often portrays patients as more passive recipients of care [ 14 , 15 , 74 , 75 ]. Shared decision-making and proactive medication are key elements as they contribute to a smoother transition and better outcomes for patients post-discharge [ 85 , 86 , 87 ].

Consistent with the literature, the study identifies some challenges in medication initiation post-discharge [ 16 , 17 , 88 ] but our results also describe how daily routine rapidly takes over, either solidifying adherence behavior or generating barriers to medication adherence. Participants’ nonadherence prior to hospitalization was a factor influencing participants’ adherence post-hospitalization and this association should be further investigated, as literature showed that hospitalized patients have high scores of non-adherence [ 89 ]. Mortel et al. showed that more than 20% of discharged patients stopped their medications earlier than agreed with the physician and 25% adapted their medication intake [ 90 ]. Furthermore, patients who self-managed their medications had a lower perception of the necessity of their medication than patients who received help, which could negatively impact medication adherence [ 91 ]. Although participants in our study had high BMQ scores for necessity and lower scores for concerns, some participants expressed doubts about the need for their medications and a lack of motivation a few weeks after discharge. Targeted pharmacy interventions for newly prescribed medications have been shown to improve medication adherence, and hospital discharge is an opportune moment to implement this service [ 92 , 93 ].

Many medication changes were made during the transition of care (a median number of 7 changes during hospitalization and 7 changes during the two months after discharge), especially medication additions during hospitalization and interruptions after hospitalization. While medication changes during hospitalization are well described, the many changes following discharge are less discussed [ 7 , 94 ]. A Danish study showed that approximately 65% of changes made during hospitalization were accepted by primary healthcare professionals but only 43% of new medications initiated during hospitalization were continued after discharge [ 95 ]. The numerous changes after discharge may be caused by unnecessary intensification of medications during hospitalization, delayed discharge letters, lack of standardized procedures, miscommunication, patient self-management difficulties, or in response to an acute situation [ 96 , 97 , 98 ]. During the transition of care, in our study, both new and experienced participants were faced with difficulties in managing and understanding medication changes, either for newly prescribed medication or changes in previous medications. Such difficulties corroborate the findings of the literature [ 9 , 10 , 47 ] and our results showed that the lack of understanding during hospitalization led to participants having questions about their medications, even weeks after discharge. Particular attention should be given to patients’ understanding of medication changes jointly by physicians, nurses and pharmacists during the transition of care and in the months that follow as medications are likely to undergo as many changes as during hospitalization.

Implication for practice and future research

The patients’ perspectives in this study showed, at a system level, that there was a lack of standardization in healthcare professional practices regarding medication dispensing and follow-up. For now, in Switzerland, there are no official guidelines on medication prescription and dispensation during the transition of care although some international guidelines have been developed for outpatient healthcare professionals [ 3 , 99 , 100 , 101 , 102 ]. Here are some suggestions for improvement arising from our results. Patients should be included as partners and healthcare professionals should systematically assess (i) previous medication adherence, (ii) patients’ desired level of involvement and (iii) their needs for information during hospitalization. Hospital discharge processes should be routinely implemented to standardize hospital discharge preparation, medication prescribing, and dispensing. Discharge from the hospital should be planned with community pharmacies to ensure that all medications are available and, if necessary, doses of medications should be supplied by the hospital to bridge the gap. A partnership with outpatient healthcare professionals, such as general practitioners, community pharmacists, and homecare nurses, should be set up for effective asynchronous interprofessional collaboration to consolidate patients’ medication management, knowledge, and adherence, as well as to monitor signs of deterioration or adverse drug events.

Future research should consolidate our first attempt to develop a framework to better characterize medication at the transition of care, using Fig. 2   as a starting point. Contextualized interventions, co-designed by health professionals, patients and stakeholders, should be tested in a hybrid implementation study to test the implementation and effectiveness of the intervention for the health system [ 103 ].

Limitations

This study has some limitations. First, the transcripts were validated for accuracy by the interviewer but not by a third party, which could have increased the robustness of the transcription. Nevertheless, the interviewer followed all methodological recommendations for transcription. Second, patient inclusion took place during the COVID-19 pandemic, which may have had an impact on patient care and the availability of healthcare professionals. Third, we cannot guarantee the accuracy of some participants’ medication history before hospitalization, even though we contacted the participants’ main pharmacy, as participants could have gone to different pharmacies to obtain their medications. Fourth, our findings may not be generalizable to other populations and other healthcare systems because some issues may be specific to multimorbid patients with type 2 diabetes or to the Swiss healthcare setting. Nevertheless, issues encountered by our participants regarding their medications correlate with findings in the literature. Fifth, only 15 out of 21 participants took part in all the interviews, but most participants took part in at least three interviews and data saturation was reached. Lastly, by its qualitative and longitudinal design, it is possible that the discussion during interviews and participants’ reflections between interviews influenced participants’ management, knowledge, and adherence, even though this study was observational, and no advice or recommendations were given by the interviewer during interviews.

Discharged patients are willing to take steps to better manage, understand, and adhere to their medications, yet they are also faced with difficulties in the hospital and outpatient care. Furthermore, extensive changes in medications not only occur during hospitalization but also during the two months following hospital discharge, for which healthcare professionals should give particular attention. The different degrees of patients’ involvement, needs and resources should be carefully considered to enable them to better manage, understand and adhere to their medications. At a system level, patients’ experiences revealed a lack of standardization of medication practices during the transition of care. The healthcare system should provide the ecosystem needed for healthcare professionals responsible for or involved in the management of patients’ medications during the hospital stay, discharge, and outpatient care to standardize their practices while considering the patient as an active partner.

Data availability

The anonymized quantitative survey datasets and the qualitative codes are available in French from the corresponding author on reasonable request.

Abbreviations

adverse drug events

Adherence Visual Analogue Scale

Belief in Medication Questionnaire

Consolidated Criteria for Reporting Qualitative Research

case report form

standard deviation

World Health Organization

American Academy of Family Physician. Continuity of Care, Definition of 2020. Accessed 10 July 2022 https://www.aafp.org/about/policies/all/continuity-of-care-definition.html

Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41.

Article   CAS   PubMed   Google Scholar  

World Health Organization (WHO). Medication Safety in Transitions of Care. 2019.

Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161–7.

Article   PubMed   Google Scholar  

Krumholz HM. Post-hospital syndrome–an acquired, transient condition of generalized risk. N Engl J Med. 2013;368(2):100–2.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Banholzer S, Dunkelmann L, Haschke M, Derungs A, Exadaktylos A, Krähenbühl S, et al. Retrospective analysis of adverse drug reactions leading to short-term emergency hospital readmission. Swiss Med Wkly. 2021;151:w20400.

Blozik E, Signorell A, Reich O. How does hospitalization affect continuity of drug therapy: an exploratory study. Ther Clin Risk Manag. 2016;12:1277–83.

Article   PubMed   PubMed Central   Google Scholar  

Allen J, Hutchinson AM, Brown R, Livingston PM. User experience and care for older people transitioning from hospital to home: patients’ and carers’ perspectives. Health Expect. 2018;21(2):518–27.

Daliri S, Bekker CL, Buurman BM, Scholte Op Reimer WJM, van den Bemt BJF, Karapinar-Çarkit F. Barriers and facilitators with medication use during the transition from hospital to home: a qualitative study among patients. BMC Health Serv Res. 2019;19(1):204.

Bekker CL, Mohsenian Naghani S, Natsch S, Wartenberg NS, van den Bemt BJF. Information needs and patient perceptions of the quality of medication information available in hospitals: a mixed method study. Int J Clin Pharm. 2020;42(6):1396–404.

Foulon V, Wuyts J, Desplenter F, Spinewine A, Lacour V, Paulus D, et al. Problems in continuity of medication management upon transition between primary and secondary care: patients’ and professionals’ experiences. Acta Clin Belgica: Int J Clin Lab Med. 2019;74(4):263–71.

Article   Google Scholar  

Micheli P, Kossovsky MP, Gerstel E, Louis-Simonet M, Sigaud P, Perneger TV, et al. Patients’ knowledge of drug treatments after hospitalisation: the key role of information. Swiss Med Wkly. 2007;137(43–44):614–20.

PubMed   Google Scholar  

Ziaeian B, Araujo KL, Van Ness PH, Horwitz LI. Medication reconciliation accuracy and patient understanding of intended medication changes on hospital discharge. J Gen Intern Med. 2012;27(11):1513–20.

Allen J, Hutchinson AM, Brown R, Livingston PM. User experience and care integration in Transitional Care for older people from hospital to home: a Meta-synthesis. Qual Health Res. 2016;27(1):24–36.

Mackridge AJ, Rodgers R, Lee D, Morecroft CW, Krska J. Cross-sectional survey of patients’ need for information and support with medicines after discharge from hospital. Int J Pharm Pract. 2018;26(5):433–41.

Mulhem E, Lick D, Varughese J, Barton E, Ripley T, Haveman J. Adherence to medications after hospital discharge in the elderly. Int J Family Med. 2013;2013:901845.

Fallis BA, Dhalla IA, Klemensberg J, Bell CM. Primary medication non-adherence after discharge from a general internal medicine service. PLoS ONE. 2013;8(5):e61735.

Zhou L, Rupa AP. Categorization and association analysis of risk factors for adverse drug events. Eur J Clin Pharmacol. 2018;74(4):389–404.

Moreau-Gruet F. La multimorbidité chez les personnes de 50 ans et plus. Résultats basés sur l’enqête SHARE (Survey of Health, Ageing and Retirement in Europe. Obsan Bulletin 4/2013. 2013(Neuchâtel: OBservatoire suisse de la santé).

Iglay K, Hannachi H, Joseph Howie P, Xu J, Li X, Engel SS, et al. Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus. Curr Med Res Opin. 2016;32(7):1243–52.

Sibounheuang P, Olson PS, Kittiboonyakun P. Patients’ and healthcare providers’ perspectives on diabetes management: a systematic review of qualitative studies. Res Social Adm Pharm. 2020;16(7):854–74.

Müller-Wieland D, Merkel M, Hamann A, Siegel E, Ottillinger B, Woker R, et al. Survey to estimate the prevalence of type 2 diabetes mellitus in hospital patients in Germany by systematic HbA1c measurement upon admission. Int J Clin Pract. 2018;72(12):e13273.

Blanc AL, Fumeaux T, Stirnemann J, Dupuis Lozeron E, Ourhamoune A, Desmeules J, et al. Development of a predictive score for potentially avoidable hospital readmissions for general internal medicine patients. PLoS ONE. 2019;14(7):e0219348.

Hansen LO, Greenwald JL, Budnitz T, Howell E, Halasyamani L, Maynard G, et al. Project BOOST: effectiveness of a multihospital effort to reduce rehospitalization. J Hosp Med. 2013;8(8):421–7.

Khalid JM, Raluy-Callado M, Curtis BH, Boye KS, Maguire A, Reaney M. Rates and risk of hospitalisation among patients with type 2 diabetes: retrospective cohort study using the UK General Practice Research Database linked to English Hospital Episode statistics. Int J Clin Pract. 2014;68(1):40–8.

Lussier ME, Evans HJ, Wright EA, Gionfriddo MR. The impact of community pharmacist involvement on transitions of care: a systematic review and meta-analysis. J Am Pharm Assoc. 2020;60(1):153–.

van der Heijden A, de Bruijne MC, Nijpels G, Hugtenburg JG. Cost-effectiveness of a clinical medication review in vulnerable older patients at hospital discharge, a randomized controlled trial. Int J Clin Pharm. 2019;41(4):963–71.

Bingham J, Campbell P, Schussel K, Taylor AM, Boesen K, Harrington A, et al. The Discharge Companion Program: an interprofessional collaboration in Transitional Care Model Delivery. Pharm (Basel). 2019;7(2):68.

Google Scholar  

Farris KB, Carter BL, Xu Y, Dawson JD, Shelsky C, Weetman DB, et al. Effect of a care transition intervention by pharmacists: an RCT. BMC Health Serv Res. 2014;14:406.

Meslot C, Gauchet A, Hagger MS, Chatzisarantis N, Lehmann A, Allenet B. A Randomised Controlled Trial to test the effectiveness of planning strategies to improve Medication Adherence in patients with Cardiovascular Disease. Appl Psychol Health Well Being. 2017;9(1):106–29.

Garnier A, Rouiller N, Gachoud D, Nachar C, Voirol P, Griesser AC, et al. Effectiveness of a transition plan at discharge of patients hospitalized with heart failure: a before-and-after study. ESC Heart Fail. 2018;5(4):657–67.

Daliri S, Bekker CL, Buurman BM, Scholte Op Reimer WJM, van den Bemt BJF, Karapinar-Çarkit F. Medication management during transitions from hospital to home: a focus group study with hospital and primary healthcare providers in the Netherlands. Int J Clin Pharm. 2020.

Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011;155(8):520–8.

Leppin AL, Gionfriddo MR, Kessler M, Brito JP, Mair FS, Gallacher K, et al. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Intern Med. 2014;174(7):1095–107.

Donzé J, John G, Genné D, Mancinetti M, Gouveia A, Méan M et al. Effects of a Multimodal Transitional Care Intervention in patients at high risk of readmission: the TARGET-READ Randomized Clinical Trial. JAMA Intern Med. 2023.

Rodrigues CR, Harrington AR, Murdock N, Holmes JT, Borzadek EZ, Calabro K, et al. Effect of pharmacy-supported transition-of-care interventions on 30-Day readmissions: a systematic review and Meta-analysis. Ann Pharmacother. 2017;51(10):866–89.

Lam MYY, Dodds LJ, Corlett SA. Engaging patients to access the community pharmacy medicine review service after discharge from hospital: a cross-sectional study in England. Int J Clin Pharm. 2019;41(4):1110–7.

Hossain LN, Fernandez-Llimos F, Luckett T, Moullin JC, Durks D, Franco-Trigo L, et al. Qualitative meta-synthesis of barriers and facilitators that influence the implementation of community pharmacy services: perspectives of patients, nurses and general medical practitioners. BMJ Open. 2017;7(9):e015471.

En-Nasery-de Heer S, Uitvlugt EB, Bet PM, van den Bemt BJF, Alai A, van den Bemt P et al. Implementation of a pharmacist-led transitional pharmaceutical care programme: process evaluation of medication actions to reduce hospital admissions through a collaboration between Community and Hospital pharmacists (MARCH). J Clin Pharm Ther. 2022.

Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510–20.

De Geest S, Zúñiga F, Brunkert T, Deschodt M, Zullig LL, Wyss K, et al. Powering Swiss health care for the future: implementation science to bridge the valley of death. Swiss Med Wkly. 2020;150:w20323.

Noonan VK, Lyddiatt A, Ware P, Jaglal SB, Riopelle RJ, Bingham CO 3, et al. Montreal Accord on patient-reported outcomes (PROs) use series - paper 3: patient-reported outcomes can facilitate shared decision-making and guide self-management. J Clin Epidemiol. 2017;89:125–35.

Hesselink G, Schoonhoven L, Barach P, Spijker A, Gademan P, Kalkman C, et al. Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med. 2012;157(6):417–28.

(OFSP) Interprofessionnalité dans le domaine de la santé Soins ambulatoire. Accessed 4 January 2024. https://www.bag.admin.ch/bag/fr/home/strategie-und-politik/nationale-gesundheitspolitik/foerderprogramme-der-fachkraefteinitiative-plus/foerderprogramme-interprofessionalitaet.html

Mitchell SE, Laurens V, Weigel GM, Hirschman KB, Scott AM, Nguyen HQ, et al. Care transitions from patient and caregiver perspectives. Ann Fam Med. 2018;16(3):225–31.

Davoody N, Koch S, Krakau I, Hägglund M. Post-discharge stroke patients’ information needs as input to proposing patient-centred eHealth services. BMC Med Inf Decis Mak. 2016;16:66.

Ozavci G, Bucknall T, Woodward-Kron R, Hughes C, Jorm C, Joseph K, et al. A systematic review of older patients’ experiences and perceptions of communication about managing medication across transitions of care. Res Social Adm Pharm. 2021;17(2):273–91.

Fylan B, Armitage G, Naylor D, Blenkinsopp A. A qualitative study of patient involvement in medicines management after hospital discharge: an under-recognised source of systems resilience. BMJ Qual Saf. 2018;27(7):539–46.

Fylan B, Marques I, Ismail H, Breen L, Gardner P, Armitage G, et al. Gaps, traps, bridges and props: a mixed-methods study of resilience in the medicines management system for patients with heart failure at hospital discharge. BMJ Open. 2019;9(2):e023440.

Brandberg C, Ekstedt M, Flink M. Self-management challenges following hospital discharge for patients with multimorbidity: a longitudinal qualitative study of a motivational interviewing intervention. BMJ Open. 2021;11(7):e046896.

Lawton J, Rankin D, Peel E, Douglas M. Patients’ perceptions and experiences of transitions in diabetes care: a longitudinal qualitative study. Health Expect. 2009;12(2):138–48.

Mabire C, Bachnick S, Ausserhofer D, Simon M. Patient readiness for hospital discharge and its relationship to discharge preparation and structural factors: a cross-sectional study. Int J Nurs Stud. 2019;90:13–20.

Meyers DC, Durlak JA, Wandersman A. The quality implementation framework: a synthesis of critical steps in the implementation process. Am J Community Psychol. 2012;50(3–4):462–80.

Meyer-Massetti C, Hofstetter V, Hedinger-Grogg B, Meier CR, Guglielmo BJ. Medication-related problems during transfer from hospital to home care: baseline data from Switzerland. Int J Clin Pharm. 2018;40(6):1614–20.

Neeman M, Dobrinas M, Maurer S, Tagan D, Sautebin A, Blanc AL, et al. Transition of care: a set of pharmaceutical interventions improves hospital discharge prescriptions from an internal medicine ward. Eur J Intern Med. 2017;38:30–7.

Geese F, Schmitt KU. Interprofessional Collaboration in Complex Patient Care Transition: a qualitative multi-perspective analysis. Healthc (Basel). 2023;11(3).

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud. 2013;50(5):587–92.

Thomson R, Plumridge L, Holland J, Editorial. Int J Soc Res Methodol. 2003;6(3):185–7.

Audulv Å, Hall EOC, Kneck Å, Westergren T, Fegran L, Pedersen MK, et al. Qualitative longitudinal research in health research: a method study. BMC Med Res Methodol. 2022;22(1):255.

Kim H, Sefcik JS, Bradway C. Characteristics of qualitative descriptive studies: a systematic review. Res Nurs Health. 2017;40(1):23–42.

Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334–40.

Bradshaw C, Atkinson S, Doody O. Employing a qualitative description Approach in Health Care Research. Glob Qual Nurs Res. 2017;4:2333393617742282.

PubMed   PubMed Central   Google Scholar  

Bellone JM, Barner JC, Lopez DA. Postdischarge interventions by pharmacists and impact on hospital readmission rates. J Am Pharm Assoc (2003). 2012;52(3):358–62.

Hennink MM, Kaiser BN, Marconi VC. Code saturation versus meaning saturation: how many interviews are Enough? Qual Health Res. 2016;27(4):591–608.

World Health Organization. Adherence to long-term therapies: evidence for action. 2003.

Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25(4):462–73.

Bandura A. Health promotion from the perspective of social cognitive theory. Psychol Health. 1998;13(4):623–49.

ShiftEUROQOL Research FOndation EQ 5D Instruments. Accessed 30 July 2022 https://euroqol.org/eq-5d-instruments/sample-demo/

Jeppesen KM, Coyle JD, Miser WF. Screening questions to predict limited health literacy: a cross-sectional study of patients with diabetes mellitus. Ann Fam Med. 2009;7(1):24–31.

Giordano TP, Guzman D, Clark R, Charlebois ED, Bangsberg DR. Measuring adherence to antiretroviral therapy in a diverse population using a visual analogue scale. HIV Clin Trials. 2004;5(2):74–9.

Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999;14(1):1–24.

Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the necessity-concerns Framework. PLoS ONE. 2013;8(12):e80633.

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101.

Waibel S, Henao D, Aller M-B, Vargas I, Vázquez M-L. What do we know about patients’ perceptions of continuity of care? A meta-synthesis of qualitative studies. Int J Qual Health Care. 2011;24(1):39–48.

Rognan SE, Jørgensen MJ, Mathiesen L, Druedahl LC, Lie HB, Bengtsson K, et al. The way you talk, do I have a choice?’ Patient narratives of medication decision-making during hospitalization. Int J Qualitative Stud Health Well-being. 2023;18(1):2250084.

Michel B, Hemery M, Rybarczyk-Vigouret MC, Wehrle P, Beck M. Drug-dispensing problems community pharmacists face when patients are discharged from hospitals: a study about 537 prescriptions in Alsace. Int J Qual Health Care. 2016;28(6):779–84.

Bruhwiler LD, Hersberger KE, Lutters M. Hospital discharge: what are the problems, information needs and objectives of community pharmacists? A mixed method approach. Pharm Pract (Granada). 2017;15(3):1046.

Knight DA, Thompson D, Mathie E, Dickinson A. Seamless care? Just a list would have helped!’ Older people and their carer’s experiences of support with medication on discharge home from hospital. Health Expect. 2013;16(3):277–91.

Gualandi R, Masella C, Viglione D, Tartaglini D. Exploring the hospital patient journey: what does the patient experience? PLoS ONE. 2019;14(12):e0224899.

Norberg H, Håkansson Lindqvist M, Gustafsson M. Older individuals’ experiences of Medication Management and Care after Discharge from Hospital: an interview study. Patient Prefer Adherence. 2023;17:781–92.

Jones KC, Austad K, Silver S, Cordova-Ramos EG, Fantasia KL, Perez DC, et al. Patient perspectives of the hospital discharge process: a qualitative study. J Patient Exp. 2023;10:23743735231171564.

Hesselink G, Flink M, Olsson M, Barach P, Dudzik-Urbaniak E, Orrego C, et al. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers. BMJ Qual Saf. 2012;21(Suppl 1):i39–49.

Murray SA, Kendall M, Carduff E, Worth A, Harris FM, Lloyd A, et al. Use of serial qualitative interviews to understand patients’ evolving experiences and needs. BMJ. 2009;339:b3702.

Berger ZD, Boss EF, Beach MC. Communication behaviors and patient autonomy in hospital care: a qualitative study. Patient Educ Couns. 2017;100(8):1473–81.

Davis RE, Jacklin R, Sevdalis N, Vincent CA. Patient involvement in patient safety: what factors influence patient participation and engagement? Health Expect. 2007;10(3):259–67.

Greene J, Hibbard JH. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med. 2012;27(5):520–6.

Mitchell SE, Gardiner PM, Sadikova E, Martin JM, Jack BW, Hibbard JH, et al. Patient activation and 30-day post-discharge hospital utilization. J Gen Intern Med. 2014;29(2):349–55.

Weir DL, Motulsky A, Abrahamowicz M, Lee TC, Morgan S, Buckeridge DL, et al. Failure to follow medication changes made at hospital discharge is associated with adverse events in 30 days. Health Serv Res. 2020;55(4):512–23.

Kripalani S, Goggins K, Nwosu S, Schildcrout J, Mixon AS, McNaughton C, et al. Medication nonadherence before hospitalization for Acute Cardiac events. J Health Commun. 2015;20(Suppl 2):34–42.

Mortelmans L, De Baetselier E, Goossens E, Dilles T. What happens after Hospital Discharge? Deficiencies in Medication Management encountered by geriatric patients with polypharmacy. Int J Environ Res Public Health. 2021;18(13).

Mortelmans L, Goossens E, Dilles T. Beliefs about medication after hospital discharge in geriatric patients with polypharmacy. Geriatr Nurs. 2022;43:280–7.

Bandiera C, Ribaut J, Dima AL, Allemann SS, Molesworth K, Kalumiya K et al. Swiss Priority setting on implementing Medication Adherence interventions as Part of the European ENABLE COST action. Int J Public Health. 2022;67.

Elliott R, Boyd M, Nde S. at e. Supporting adherence for people starting a new medication for a long-term condition through community pharmacies: a pragmaticrandomised controlled trial of the New Medicine Service. 2015.

Grimmsmann T, Schwabe U, Himmel W. The influence of hospitalisation on drug prescription in primary care–a large-scale follow-up study. Eur J Clin Pharmacol. 2007;63(8):783–90.

Larsen MD, Rosholm JU, Hallas J. The influence of comprehensive geriatric assessment on drug therapy in elderly patients. Eur J Clin Pharmacol. 2014;70(2):233–9.

Viktil KK, Blix HS, Eek AK, Davies MN, Moger TA, Reikvam A. How are drug regimen changes during hospitalisation handled after discharge: a cohort study. BMJ Open. 2012;2(6):e001461.

Strehlau AG, Larsen MD, Søndergaard J, Almarsdóttir AB, Rosholm J-U. General practitioners’ continuation and acceptance of medication changes at sectorial transitions of geriatric patients - a qualitative interview study. BMC Fam Pract. 2018;19(1):168.

Anderson TS, Lee S, Jing B, Fung K, Ngo S, Silvestrini M, et al. Prevalence of diabetes medication intensifications in older adults discharged from US Veterans Health Administration Hospitals. JAMA Netw Open. 2020;3(3):e201511.

Royal Pharmaceutical Society. Keeping patients safewhen they transfer between care providers– getting the medicines right June 2012. Accessed 27 October 2023 https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Publications/Keeping%20patients%20safe%20transfer%20of%20care%20report.pdf

International Pharmaceutical Federation (FIP). Medicines reconciliation: A toolkit for pharmacists. Accessed 23 September 2023 https://www.fip.org/file/4949

Californian Pharmacist Assiociation Transitions of Care Resource Guide. https://cdn.ymaws.com/www.cshp.org/resource/resmgr/Files/Practice-Policy/For_Pharmacists/transitions_of_care_final_10.pdf

Royal Collegue of Physicians. Medication safety at hospital discharge: Improvement guide and resource. Accessed 18 September 2023 https://www.rcplondon.ac.uk/file/33421/download

Douglas N, Campbell W, Hinckley J. Implementation science: buzzword or game changer. J Speech Lang Hear Res. 2015;58.

Download references

Acknowledgements

The authors would like to thank all the patients who took part in this study. We would also like to thank the Geneva University Hospitals Patients Partners + 3P platform as well as Mrs. Tourane Corbière and Mr. Joël Mermoud, patient partners, who reviewed interview guides for clarity and significance. We would like to thank Samuel Fabbi, Vitcoryavarman Koh, and Pierre Repiton for the transcriptions of the audio recordings.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Open access funding provided by University of Geneva

Author information

Authors and affiliations.

School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland

Léa Solh Dost & Marie P. Schneider

Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland

Division of Endocrinology, Diabetes, Hypertension and Nutrition, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland

Giacomo Gastaldi

You can also search for this author in PubMed   Google Scholar

Contributions

LS, GG, and MS conceptualized and designed the study. LS and GG screened and recruited participants. LS conducted the interviews. LS, GG, and MS performed data analysis and interpretation. LS drafted the manuscript and LS and MS worked on the different versions. MS and GG approved the final manuscript.

Corresponding authors

Correspondence to Léa Solh Dost or Marie P. Schneider .

Ethics declarations

Ethics approval and consent to participate.

Ethics approval was sought and granted by the Cantonal Research Ethics Commission, Geneva (CCER) (2020 − 01779), and informed consent to participate was obtained from all participants.

Consent for publication

Informed consent for publication was obtained from all participants.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary material 2, supplementary material 3, rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Solh Dost, L., Gastaldi, G. & Schneider, M. Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes. BMC Health Serv Res 24 , 620 (2024). https://doi.org/10.1186/s12913-024-10784-9

Download citation

Received : 28 June 2023

Accepted : 26 February 2024

Published : 13 May 2024

DOI : https://doi.org/10.1186/s12913-024-10784-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Continuity of care
• Transition of care
• Patient discharge
• Medication management
• Medication adherence
• Qualitative research
• Longitudinal studies
• Patient-centered care
• Interprofessional collaboration
• Type 2 diabetes

BMC Health Services Research

ISSN: 1472-6963

• General enquiries: [email protected]

ORIGINAL RESEARCH article

Urban green spaces and resident health: an empirical analysis from data across 30 provinces in china.

• Chengdu University of Technology, Chengdu, Sichuan Province, China

The final, formatted version of the article will be published soon.

Select one of your emails

You have multiple emails registered with Frontiers:

Notify me on publication

Please enter your email address:

If you already have an account, please login

You don't have a Frontiers account ? You can register here

Background: This study aims to explore the correlation between urban green space coverage and resident health, and to analyze its underlying mechanisms. Methods: Using panel data from 30 provinces in China from 2006 to 2022, which mainly includes urban green space coverage, general health of the population, air quality, and social connectivity. This research constructed a fixed effects model to perform baseline regression analysis. A series of robustness tests, including variable substitution, controlling for geographical differences, regional robustness tests, and shortening the time span of the study, further verified the robustness of the results. Additionally, mechanism tests were conducted to examine the positive impacts of urban green spaces on resident health by improving air quality and enhancing social connectivity. Results: The findings indicate a significant positive correlation between urban green space coverage and resident health levels. That is, the greater the area covered with urban green space, the healthier the residents of the area will be. Robustness tests support the reliability of this finding, while mechanism analysis reveals that urban green spaces have a positive impact on the health of the population by improving air quality and increasing social connectivity. Discussion: This study underscores the importance of urban green space planning in improving resident health and quality of life, providing urban planners with scientific evidence to optimize urban green systems for broader health objectives.

Keywords: Urban green spaces, Resident health, Air Quality, Social Connectivity, urban planning

Received: 29 Apr 2024; Accepted: 16 May 2024.

Copyright: © 2024 Bi, Wang, Yang, Mao and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ya Wang, Chengdu University of Technology, Chengdu, 610059, Sichuan Province, China

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.