Qualitative Health Research Research Articles

Theoretical frameworks used to inform qualitative mental health research: a focus on positivism, interpretivism and critical realism

SUMMARY Qualitative research methods, defined as the collection and analysis of non-numerical data to understand concepts and experiences, are often used to inform mental health practice and policies. When utilising qualitative research methods, it is important that the researcher uses an explicit theoretical framework to guide the study. A theoretical framework informs how researchers engage with a topic or problem, report on their work with participants, describe key concepts and address assumptions within the research questions and procedures. In this article, we describe the basic concepts underpinning three of the most commonly used frameworks in mental health research: positivism, interpretivism and critical realism. We also describe how these theoretical frameworks may guide the qualitative process, including the theoretical and methodological approaches chosen and the ways in which these theoretical frameworks can be applied in practice. To enhance understanding of these frameworks, we include examples of how such frameworks can be used in qualitative mental health research.

A Community-Informed Maternal and Infant Health Needs Assessment in Alabama.

Maternal mortality is a global clinical and public health crisis. Researchers and leading organizations have highlighted the need for local partnerships to implement evidence-based strategies to mitigate poor outcomes. Alabama has the third highest maternal mortality rate in the nation. Research on the complexity of maternity mortality is strengthening, but poor outcomes in Alabama persist and there is limited data highlighting the perspectives of those on the frontlines of providing and receiving care. We conducted a qualitative, statewide, community-informed, maternal and infant health research assessment with physicians, providers, professionals, and birthing persons to identify challenges and solutions to addressing the states' poor perinatal health outcomes. METHODS: Data were collected using a four-phase, research design that included semi-structured interviews, focus groups, one state-wide data sharing event, and five regional data sharing events. Data were collected between January 2020 and October 2021. The data were analyzed using consensus coding and thematic analysis. Fifty-nine (N = 59) individuals participated. Three themes emerged: 1) "They were making me feel so overlooked.": A disconnect between perinatal healthcare services and patient needs; 2) "That shouldn't be something you have to ask for": Limitations to providing respectful perinatal healthcare; and 3) "If they work together, they can have all the tools they need.": Building a case for collaborative care. Participants advocated for a collaborative perinatal healthcare model that focuses on the provision of respectful, quality perinatal healthcare. Our approach can be applied across contexts and used to support the effective implementation contextually relevant maternity care practices.

Answering “How” and “Why” Questions: The Value of Qualitative Research in Mental Health

Answering “How” and “Why” Questions: The Value of Qualitative Research in Mental Health

Commentary: Expanding the vision of Registered Reports for qualitative mental health research: A response and extension to 'Misaligned incentives in mental health research - the case for Registered Reports', Baldwin (2023).

There is a growing exploration of how Registered Reports can benefit individual researchers and wider research fields as part of a wider shift towards open research principles and practices. In 'Misaligned incentives in mental health research - the case for Registered Reports', Baldwin examines this in the context of mental health research, arguing that Registered Reports (RRs)can be a valuable solution to misaligned incentive structures in the field. However, this original piece was generally inclined towards how such incentives and the use of RRs can play out in the context of quantitative research. Such reflection is valuable, but to examine the case for RRs in mental health research as a field, we must also explore such practices within the context of qualitative research. In this commentary, we therefore expand and reframe this discussion to make the case for RRs in qualitative mental health research. We explore the place for qualitative research in the mental health research field and examine possibilities for how RRs fit within principles and practices in such methods. We discuss the various benefits and challenges of RRs in qualitative research, reflecting on our experiences as authors and reviewers of qualitative RRs and exploring how research infrastructure can facilitate engagement with this publishing approach.

A Field in Transition: A Scoping Review and Thematic Network Map of Qualitative Health Research in Liver Transplantation

BACKGROUNDIn liver transplantation, qualitative methodologies can offer important insights from a range of perspectives into the meaning and impact of health experiences. This review aims to characterize the existing qualitative research in liver transplantation to understand how this work has evolved over time, its contribution to understanding clinical issues, and to conceptualize under-developed areas for future research. METHODSStudies from MEDLINE, Embase, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, and Web of Science were searched from database inception to January 2024. All English language studies focused on a liver transplant population with qualitative methodological components were included. Using VOSviewer network mapping software we constructed a visualization of the thematic networks within included studies. RESULTSOur initial search yielded 9092 studies from which 229 were included in the final review. Data extraction revealed significant increases in the publication of qualitative studies since 2015, predominantly utilizing interviews and focus groups. The thematic network map we constructed placed “social support” as a dominant and central concept across many different studies, with related themes tending to cluster within four domains of research: Care of the Organ & Patienthood; Identity, Embodiment, Adjustment; Relational & Ethical Issues; Existential Themes. Medicalized subject such as “self-management” were less well-networked with identity-related, ethical, and existential topics. DISCUSSIONThere is a growing body of rich qualitative research in liver transplantation. Future research would benefit from more longitudinal approaches as well as increased attention to the interrelation between “clinical” issues (adherence, quality of life) and ethical, relational, and existential ones.

Researching local public health priorities in the locked down city using online community focus groups: Reflections and recommendations

In this commentary paper we reflect on our experiences of conducting two qualitative public health projects in Leicester UK around health inequalities and marginalised groups during the Covid 19 pandemic in 2020 and 2021. To contextualise the commentary, we first provide information about Leicester and how and why it was disproportionately affected by the pandemic, as well as describing the origins, aims, and methodologies of the two projects. In the second half, we describe and evaluate some of the adaptations we made to our studies and conclude with suggestions for future qualitative community health research as we adapt to the post-pandemic research landscape.

THE INFLUENCE OF SENIOR AUTHOR GENDER ON RESEARCH PRACTICE IN EXERCISE AND SPORTS SCIENCE

INTRODUCTION & AIMS Sex and gender bias have been continually documented in sport and exercise science. There are disparities in both participants and authorship, including those leading the research. Examples from medical research show senior author gender influences practices (e.g., disaggregation of data by sex). We examined the relationship between senior author gender and research practices in sport and exercise science. METHODS For this analysis we have included all papers published in the first issue of 2023 of the top 10 sports science journals, according to SJR Sports Science rankings. We extracted senior author gender and data on research practices including study type, exercise modality, and population. This is part of a larger ongoing study. RESULTS Our preliminary results include 182 studies from 10 journals. Men represented 84% of all senior authors. Percentage of senior author gender ranged from 100% men as senior authors in Knee Surgery, Sports Traumatology, and Arthroscopy (45 papers led by men, 0 led by women), to 66% women senior authorship in Qualitative Research in Sport, Exercise and Health (6 papers led by women, 3 by men). When the senior author was a man, they were more likely to conduct observational research, including cross sectional, retrospective, and epidemiological research. When women were senior authors, they were more likely to conduct qualitative research. Less than 4% of all letters to the editor were led by women. Approximately 25% of all studies focused on Sport. Within this category, 75% of these studies had men senior authors. Approximately 65% of all studies had a clinical focus. Within this category, 86% of these studies had men senior authors. CONCLUSIONS This preliminary data indicates some differences in research practices by senior author gender. This research also highlights differences by journal in their inclusion of research led by women.

Opportunities and Challenges of Qualitative Research in Academic Health Sciences in Ethiopia

Background. The goal of qualitative research is to learn more about the opinions and experiences of the subjects being studied in relation to a particular question. There is a paucity of information on opportunities and challenges encountered to conduct qualitative research among the academic staffs in the health sciences. The purpose of this study was to examine the opportunities and challenges of conducting qualitative research among academic staff of health sciences in Ethiopia. Methods. A descriptive qualitative study design was conducted among health sciences academic staffs of selected public universities in Ethiopia. The study was conducted at three universities’ health sciences colleges, namely, Addis Ababa University, Dilla University, and Wolaita Sodo University. Data were collected using focus group discussions, in-depth interviews, and key informant interviews. MAXQDA 2020 software was used for coding and data management. A thematic analysis approach was followed to present the results. Both inductive and deductive coding approaches were used. Results. Three main themes have been identified as follows: general research practice, opportunities for qualitative research, and challenges to conduct qualitative research. Participants indicated that the availability of research opportunities will have a good impact on qualitative research engagement. Availability of grants, funding, and other incentives and demand for qualitative research in healthcare were described as opportunities for qualitative research practice. Despite the available opportunities, study participants uncovered different challenges that encountered by health academic staffs in conducting qualitative research. Resource limitations, lack of knowledge, negative attitudes or beliefs, publication, and language issues were raised as main challenges. Conclusion. Qualitative research practices were found to be low among health sciences academics. Lack of resources, training, and expertise, problems associated with publication, a lack of funding, and a shortage of experts were the main challenges in conducting qualitative research in health sciences academic settings in Ethiopia.

Challenges and opportunities during the COVID-19 pandemic: A layered vulnerabilities perspective

The COVID-19 pandemic has had wide-ranging implications on the academic community and there have been numerous commentaries on the effects of the pandemic on qualitative health research. However, the vulnerabilities faced by participants and researchers during the pandemic have remained underexplored. Addressing this gap, this reflective article discusses the intersecting challenges and opportunities arising for participants and researchers in qualitative health research during the pandemic through the lens of layered vulnerability. Vulnerability, as a layered concept, provides novel insight to discussions on the effects of the pandemic as it provides a depth of insight into the multifaceted and dynamic nature of vulnerabilities, while considering individual differences and contexts. Reflecting on the research we conducted during the pandemic, we draw out the layers of vulnerability that both participants and researchers faced during the research process, as well as the obligations and strategies we developed to mitigate these vulnerabilities. We discuss the intersectionality of individual characteristics and the digitisation of work and life, including the impact of moving qualitative health research online and the use of creative methodological approaches. Our article highlights how, through engaging with their own vulnerabilities throughout the research process, researchers can develop creative and new solutions for qualitative research which mitigate the increased vulnerabilities participants faced during the pandemic.

Maddening Post-Qualitative Inquiry: An Exercise in Collective (Mad) Theorising.

Both post-qualitative inquiry and Mad methodologies sit on the fringes of qualitative health research, although their potential for creating new knowledges and practices is increasingly recognised. In this article, we explore the possibilities created by bringing these approaches together within research led by, or centring, mental health service users and survivors. We outline and reflect on a workshop undertaken with peer support workers to map affective intensities within mental health assemblages. We suggest the tensions between post-qualitative and Mad research approaches hold potential for mental health research, and qualitative health research more broadly, bringing together theory and the experiences of service users/survivors to think-feel-become otherwise in relation to health care, peer support, and activism.

Rethinking Barriers and Enablers in Qualitative Health Research: Limitations, Alternatives, and Enhancements.

Explorations of barriers and enablers (or barriers and facilitators) to a desired health practice, implementation process, or intervention outcome have become so prevalent that they seem to be a default in much health services and public health research. In this article, we argue that decisions to frame research questions or analyses using barriers and enablers (B&Es) should not be default. Contrary to the strengths of qualitative research, the B&Es approach often bypasses critical reflexivity and can lead to shallow research findings with poor understanding of the phenomena of interest. The B&Es approach is untheorised, relying on assumptions of linear, unidirectional processes, universally desirable outcomes, and binary thinking which are at odds with the rich understanding of context and complexity needed to respond to the challenges faced by health services and public health. We encourage researchers to develop research questions using informed deliberation that considers a range of approaches and their implications for producing meaningful knowledge. Alternatives and enhancements to the B&Es approach are explored, including using 'whole package' methodologies; theories, conceptual frameworks, and sensitising ideas; and participatory methods. We also consider ways of advancing existing research on B&Es rather than doing 'more of the same': researchers can usefully investigate how a barrier or enabler works in depth; develop and test implementation strategies for addressing B&Es; or synthesise the B&Es literature to develop a new model or theory. Illustrative examples from the literature are provided. We invite further discussion on this topic.

Call for Papers for a Special Issue Focused on Culturally Responsive Qualitative Health Research.

Call for Papers for a Special Issue Focused on Culturally Responsive Qualitative Health Research.

Is qualitative social research in global health fulfilling its potential?: a systematic evidence mapping of research on point-of-care testing in low- and middle-income contexts

BackgroundQualitative social research has made valuable contributions to understanding technology-based interventions in global health. However, we have little evidence of who is carrying out this research, where, how, for what purpose, or the overall scope of this body of work. To address these questions, we undertook a systematic evidence mapping of one area of technology-focused research in global health, related to the development, deployment and use of point-of-care tests (POCTs) for low-and middle-income countries (LMICs).MethodsWe conducted an exhaustive search to identify papers reporting on primary qualitative studies that explore the development, deployment, and use of POCTs in LMICs and screened results to identify studies meeting the inclusion criteria. Data were extracted from included studies and descriptive analyses were conducted.ResultsOne hundred thirty-eight studies met our inclusion criteria, with numbers increasing year by year. Funding of studies was primarily credited to high income country (HIC)-based institutions (95%) and 64% of first authors were affiliated with HIC-based institutions. Study sites, in contrast, were concentrated in a small number of LMICs. Relatively few studies examined social phenomena related to POCTs that take place in HICs. Seventy-one percent of papers reported on studies conducted within the context of a trial or intervention. Eighty percent reported on studies considering POCTs for HIV and/or malaria. Studies overwhelmingly reported on POCT use (91%) within primary-level health facilities (60%) or in hospitals (30%) and explored the perspectives of the health workforce (70%).ConclusionsA reflexive approach to the role, status, and contribution of qualitative and social science research is crucial to identifying the contributions it can make to the production of global health knowledge and understanding the roles technology can play in achieving global health goals. The body of qualitative social research on POCTs for LMICs is highly concentrated in scope, overwhelmingly focuses on testing in the context of a narrow number of donor-supported initiatives and is driven by HIC resources and expertise. To optimise the full potential of qualitative social research requires the promotion of open and just research ecosystems that broaden the scope of inquiry beyond established public health paradigms and build social science capacity in LMICs.

Addressing Race in Fieldnotes in Qualitative Health Research: A Methodological Critique

Attention has recently been given to the role of race in many aspects of the research process; however, minimal has been written to critique the role of race in qualitative fieldnotes. This gap creates potential conflicts about representation that can exclude marginalized communities and call into question findings when race is ignored in the research process. To successfully address potential investigator biases with a lens towards social justice and equity in healthcare, a critique of foundational methods is required. Here we posit that a qualitative health researchers’ primary tool is their fieldnotes because they contextualize findings and serve as a method to learn through systematic interpretation of local meanings revealed by participants. Here, we provide researchers guidance for teaching and writing fieldnotes that speak to current nuances of observations and interactions with participants. Definitions related to race and ethnicity, the importance of applying appropriate sensitizing frameworks, followed by a discussion of how to use fieldnotes in findings are covered. We include (1) a call for more preparation of novice researchers and a challenge for established researchers to update expertise for collecting and using fieldnotes in the research process, (2) guidance on negotiating difficult situations, and (3) the significance of language in creating credibility in findings when addressing race in qualitative research.

Rapid Group Analysis Process (Rap-GAP): A Novel Approach to Expedite Qualitative Health Research Data Analysis

To contribute to healthcare improvements, qualitative health research must adapt to the demanding pace of constantly changing healthcare practices and policies. To meet this challenge, researchers need methods for rigorous and rapid data analysis. This article introduces the Rapid Group Analysis Process (Rap-GAP), a new approach for rapid qualitative data analysis. This method is more efficient than other rapid qualitative analysis methods. It allows for the direct involvement of diverse participants in the analysis process, including patients or healthcare decision-makers with limited qualitative research experience, while keeping the analysis grounded in the primary data (e.g., transcripts). These attributes make Rap-GAP a unique and valuable alternative to traditional qualitative analysis. This article describes the 5-step Rap-GAP process and 3 case studies that demonstrate how to use the method and adapt it for different analytical goals. Future research will evaluate and describe the outcomes of Rap-GAP compared to traditional qualitative analysis.

Remote and Equitable Inductive Analysis for Global Health Teams: Using Digital Tools to Foster Equity and Collaboration in Qualitative Global Health Research via the R-EIGHT Method.

Qualitative methods encompass a variety of research and analysis techniques which have the common aim of uncovering what cannot be captured numerically through the quantification of data. For qualitative analytical methods in the interpretivist tradition (e.g. grounded theory, phenomenological, thematic, etc), inductive coding has become a mainstay but has not always lent itself to collaborative, remote team-based data interpretation among qualitative and mixed-methods clinical researchers. Finding ways to speed the inductive coding process without sacrificing rigour while remaining accessible to geographically dispersed teams remains a priority. This is especially crucial in global health partnerships where on-the-ground researchers may have less input into codebook development compared to in-the-office researchers. We describe a newly-developed, digital approach that integrates findings from our qualitative team, which we call R-EIGHT (Remote and Equitable Inductive Analysis for Global Health Teams). The technique we developed a) speeds the process of inductive coding as a team, b) visually displays interpretive consensus, and c) when appropriate fosters streamlined integration of inductive findings into codebooks. Because it involves all team members, our approach helps break the divide between in-office and on-the-ground teams, fostering integrated and representative contributions from all globally-dispersed team members.

Experiences of Fathers in Norway Attending an Online Course on Therapeutic Writing After the Death of a Child.

After the unexpected death of a child, bereaved parents require prompt access to helpful support systems. Online therapeutic writing courses can make such support accessible. Because few studies have included bereaved fathers as participants, we explored the experiences of fathers whose children died unexpectedly and who were part of an online course of therapeutic writing in Norway. We piloted two courses (group 1, six weeks, n = 9; group 2, 5weeks, n = 5). We describe our methodological considerations for using poetic representations in qualitative health research and present four poetic representations based on fieldwork notes written by the principal investigator. Then, we triangulate and narratively analyze them together with two collective poems written by participants from each group; excerpts of the writings from two fathers, one per group; evaluation surveys (n = 4; n = 3); and, anonymous check-out journaling from the second group (n = 3). Resistance was a salient feature of our participants' grief, and writing enabled them to both be in contact with their emotional world and process difficult emotions as they looked for meaning despite the death of their children. Those who attended the most classes perceived the course as transformative, being part of an ongoing self-exploration, and a possibility to continue and strengthen the bond with their children. Our findings mirror the complexities of the grief experiences of fathers, giving account of their need to find a rhythm to dive into their emotional world, the importance of peer support, and the value of diversifying intervention techniques to meet individual needs and preferences.

Critically appraising and utilising qualitative health research evidence in nutrition practice.

Evidence-based decision-making and practice recommendations are commonly based on findings from quantitative studies or reviews. In the present study, we provide an overview of how to incorporate findings from qualitative research into the evidence-based decision-making process. To illustrate how qualitative evidence can be integrated into the decision-making process, we have outlined a clinical nutrition scenario and the process for sourcing credible evidence to inform decision-making. A qualitative health research study was selected and appraised using the Critical Appraisal Skill Programme (CASP) appraisal tool for qualitative research. Based on the results of the critical appraisal, the study quality is considered, and we discuss whether the qualitative evidence can be applied to practice. A detailed description of how the qualitative findings can be used conceptually and instrumentally in practice to address the clinical nutrition scenario is provided. Developing skills in critically appraising findings from qualitative studies will increase awareness and utilisation of this type of evidence in practice and policy, with a goal to ensure that patient/client perceptions are considered, leading to enhanced person-centred care or systems.

Online qualitative research with disabled children and young people in Scotland: A reflection on its advantages and disadvantages, and how limitations were addressed

With the COVID-19 pandemic, online recruitment strategies and data generation processes have become popular in social science research. Although online and creative methods, such as digital photo elicitation, online interviews, and discussion forums are increasingly used in qualitative health research, their use with disabled children and young people is not well established. Drawing on the online methodological approach used for a qualitative study conducted with disabled children and young people in Scotland, exploring their experiences of accessing healthcare and other supports during the pandemic, we reflect on our concerns and learning in relation to a digital interviewing process. Limitations and challenges of online and digital methods were varied and partially addressed by both research subjects and researchers. A significant limitation entailed the digital divide, which meant that families without the equipment and connectivity might have had less opportunity to hear about the research and participate. However, an online approach minimised travel costs, facilitated interview data transcription and, most importantly, offered children and young people a variety of participative and digital tools to talk about their experiences. Our paper raises questions on the assumptions often made about the difficulty of doing research with disabled children and young people by highlighting the benefits of this approach. It also suggests that some limitations can be addressed by engaging in collaborative and creative work between research participants and researchers.

Key Informants in Applied Qualitative Health Research.

Identifying and recruiting key informants is a widely used sampling strategy in applied qualitative health research. Key informants were first conceptualized within ethnography, but there is little methodological guidance about how to use this technique outside of that research tradition. The objective of this article is to offer practical suggestions about how existing methods for data collection with key informants could be translated to methodologies commonly used in applied qualitative health research. This article delineates how key informants could be conceptualized and sampled and how data sufficiency can be approached. The article prompts deeper consideration of the politics of representation and epistemic power that are inherent to the use of key informants in applied qualitative health research.