Qualitative research: not everything that counts can be counted

When you’re collecting data (be it using MRIs, psychometric measures, blood samples), have you ever found that participants tell you lots of interesting things that are relevant to your research but you have nowhere to record them? You realise these things don’t necessarily answer your research question or contribute to proving/disproving your hypotheses, but you recognise they are important. You can’t quantify them. You can’t see them on a brain scan; in fact, you can’t see them at all. But they provide valuable insight into how the things you’re researching affect people’s lives and you ask, ‘how can I capture them?’ This is where qualitative research comes into play.

Qualitative researchers are interested in how people experience the world and how they make sense of their experiences. Research questions tend to focus on what and how. How do health researchers experience patient and public involvement (Boylan, Locock, Thompson & Staniszewska, 2019)? What are public perceptions of survivors of brain injury (Linden & Boylan, 2010)? What is it like to live with a life-changing injury (Boylan, 2013)?

Qualitative research is highly useful when studying under-explored topics and ultimately goes hand-in-hand with quantitative approaches (e.g. Boylan, Turk, van Velthoven et al., 2020). It can be used to develop hypotheses and has an increasingly important role to play in clinical trials in intervention development, process evaluations and explaining outcomes (Cheng & Metcalfe, 2018). It is fast becoming an expected part of evaluating complex interventions (Moore et al., 2015), and provides the type of context needed to understand why or how an intervention has worked or not.

In its own right, qualitative research is a largely inductive approach; it is not hypothesis-driven and with good reason. It aims to explore phenomena from other people’s perspectives, so defining what we’re looking for in advance could mean we miss what is actually important. Data are collected through interviews, focus groups, observations or other artefacts, such as documents. Data collection happens in natural settings (homes, workplaces), far from the laboratories most may imagine when thinking about research. Analysis aims to explain and describe the commonalities, differences and meanings of experiences.

Qualitative research is often maligned for being anecdotal and for employing small samples, but these criticisms are unfair and usually made by those with no qualitative training. Sampling is considered and strategic, and small samples allow for richer data, greater engagement with it and ultimately a deeper understanding of the phenomenon under investigation. Conducted well, qualitative research is highly systematic and rigorous, and offers valuable insight into human behaviour. It provides an alternative to what Kastenbaum (2009) described as ‘indeterminate statistical zones that construct people who never were and never could be’ by shining a light on individual experience.

So when you next find yourself reading the handwritten notes participants have made all over that questionnaire or when you catch yourself wondering what life is like for the person whose MRI scan you’re interpreting, know you can turn to qualitative research.

 

Dr Anne-Marie Boylan is the Director of the Postgraduate Certificate in Qualitative Health Research Methods. She leads a programme of teaching on qualitative research on the MSc in Evidence Based Health Care. She is a Departmental Lecturer and Senior Researcher in the Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences.

 

References

Boylan, A‐M, Locock, L, Thomson, R, Staniszewska, S. “About sixty per cent I want to do it”: Health researchers’ attitudes to, and experiences of, patient and public involvement (PPI)—A qualitative interview study. Health Expect. 2019; 22: 721– 730. https://doi.org/10.1111/hex.12883

Linden MA, Boylan AM. 'To be accepted as normal': Public understanding and misconceptions concerning survivors of brain injury. Brain Inj. 2010;24(4):642-50. doi: 10.3109/02699051003601689. PMID: 20235767.

Boylan, A-M. Londoners’ experiences of life-changing injuries. Healthtalk. 2013 https://healthtalk.org/londoners-experiences-life-changing-injuries/overview

Boylan A, Turk A, van Velthoven MH, et al. Online patient feedback as a measure of quality in primary care: a multimethod study using correlation and qualitative analysis. BMJ Open 2020;10:e031820. doi: 10.1136/bmjopen-2019-031820

Cheng KKF, Metcalfe A. Qualitative Methods and Process Evaluation in Clinical Trials Context: Where to Head to? International Journal of Qualitative Methods. December 2018. doi:10.1177/1609406918774212

Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ 2015; 350: h1258 doi:10.1135/bmj.h1258