Qualitative Health Research Research Articles

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.

Care, comfort, and capacity: The importance of being flexible in research with Disabled and chronically ill people

Flexible research approaches, which account for the uncertainties of everyday life, have long been utilised by Crip Theorists and Critical Disability Scholars. The uptake of such adaptive, flexible approaches has grown further since the start of the COVID-19 crisis due to safety measures which restricted face-to-face work and social gatherings. This paper pushes for an invigorated embrace of bendable remote methods which prioritise the comfortabilities and capacities of Disabled and chronically ill participants. Through examples from ongoing research in the UK with young ‘Ostomates’, the paper reflects on the design, recruitment, and utilisation of flexible interview and diary methods when researching remotely with young people living with an ileostomy or colostomy. A flexible approach allows participants to choose an interview and diary format (for example, typed, handwritten, audio/video recorded, photographed, text-messaged, phone or Zoom call) as well as the length, date, and time of the task. Further to this, participants decide whether to contribute to the research synchronously in an interview conversation, or asynchronously ‘over-time’. Flexibility across the research design provides a way to think about and ‘do’ traditional research methods differently; and a ‘cripping’ of research time and practice responds to the embodied and fluctuating nature of chronic illness. Acknowledging and working with participants' individual personalities, responsibilities, skills, and preferences opens research to people who might otherwise be excluded, and as such, amplifies their voices and experiences. This paper recommends a flexible approach to qualitative health research as a ‘care-full’ response to the complexity of participants' everyday lives.

Qualitative health research and procedural ethics: An interview study to investigate researchers’ ways of navigating the demands of medical research ethics committees in Germany

This study explores how qualitative health researchers navigate the demands of medical research ethics committees in Germany where qualitative research is subject to approval only when it is conducted in medical contexts. We present the results of a grounded theory study to investigate qualitative health researchers’ experiences with procedural ethics and the strategies they adopt to navigate its demands. Our analysis revealed six dimensions of experience and three strategies adopted by researchers to navigate the demands of medical research ethics committees. All participants agreed that research ethics is of high importance in qualitative health research, but strategies to navigate the demands of medical research ethics committees ranged from avoiding, and adapting, to transforming the procedures of ethics review. Based on our findings, we provide recommendations for improving the ethics review of qualitative health research.

‘Being there’ is what matters: Methodological and ethical challenges when undertaking research on the outdoor environment with older people during and beyond the COVID-19 pandemic

This paper reflects on adapting research methods and processes during the COVID-19 pandemic, drawing on our experiences of conducting research on the outdoor environment with older people (aged 50+) living in Scotland. First, we discuss the challenges to the organisation of research experienced in the context of changing government and university guidelines and managing delays to planned research timelines. The shift toward remote methods stimulated by the pandemic transformed traditional notions of the research field. We consider some of the implications of this for outdoor environment research, grounded as it is on exploring the interaction between people and the places they are embedded within. Further, despite a growth of literature highlighting the benefits of remote research, we found uses for digital and online approaches limited when working with older people. Second, we reflect on whether research with older people in the context of a pandemic can be conducted ethically. Drawing on our research we describe how developing an ‘ethics of care’ included negotiating with formal ethics processes but also the relational, situated ethics of qualitative health research that, because of the pandemic, had begun to shift in new ways. We describe the often intangible impacts of COVID-19 such as social isolation and bereavement that we uncovered as researchers entering into the lives of older people. In closing, we outline some of the key lessons learnt from conducting research on outdoor environments with older people to enable future qualitative health research during and beyond the pandemic.

Qualitative Methodology in Translational Health Research: Current Practices and Future Directions.

Translational health research is an interdisciplinary field aimed at bridging the gap between basic science studies, preventative studies, and clinical practice to improve health-related outcomes. Qualitative research methods provide a unique perspective on the emotional, social, cultural, and contextual factors that influence health and healthcare and thus are recognized as valuable tools for translational health research. This approach can be embedded within a mixed method design which complements the quantitative findings. This methodological paper aims to provide a comprehensive review of the fundamental concepts and methodologies used in qualitative research, emphasizing their utilization and significance in translational health research. Several approaches to qualitative research methodology are discussed in this review, including ethnography, phenomenology, grounded theory, case study, and action research. Theoretical frameworks such as the social-ecological model, intersectionality, and participatory action research are also examined to provide a structure for understanding and interpreting complex health issues. This methodological paper also reviews commonly used sampling techniques such as purposive, snowball, convenience, theoretical, and maximum variation sampling, along with data collection methods such as in-depth interviews, focus groups, observation, document analysis, and participatory methods. Moreover, data analysis techniques such as thematic analysis, grounded theory, content analysis, narrative analysis, and reflexive analysis, are discussed in the context of translational health. Overall, this review highlights the challenges and opportunities of using qualitative methods in current practice, while also discussing future directions and providing valuable guidance and insights to researchers interested in conducting qualitative research in translational health.

Online Focus Group Discussions to Engage Stigmatized Populations in Qualitative Health Research: Lessons Learned

Community participation in research involving stigmatized populations has been sub-optimal, and digital tools could potentially increase participation in qualitative research. This study aims to describe the implementation of an online chat-based FGD (Focus Group Discussion) with men who have sex with men (MSM) in China as part of formative research for the PIONEER project, determine the advantages and limitations associated with the approach, and assess the feasibility of deepening community participation in STI research. Participants were involved in four days of asynchronous FGDs on sexually transmitted diseases and answered questions about the online FGD method. Online FGDs allowed us to deepen participant engagement through bidirectional communication channels. Data from online FGDs directly informed recruitment strategies and community participation for a clinical trial. Overall, 63% (29/46) of men who had never participated in offline LGBTQ + activities joined online FGDs. Many participants (89%, 41/46) noted that online FGDs were more convenient, less socially awkward, and more anonymous than in-person qualitative research. We highlighted potential risks as well as mitigation strategies when using online FGDs. Online FGDs were feasible among this group of sexual minorities and may be particularly useful in many cities where stigma limits in-person research participation.

An Exploration of the Effects of Gene-Editing Technology on Human Identity

An Exploration of the Effects of Gene-Editing Technology on Human Identity

Learning from pandemic precarity: The future of early career researchers in qualitative health research

This commentary is a critical reflection by early career researchers (ECRs) working in qualitative health research (QHR) during the COVID-19 pandemic. The consequences of the pandemic have been acutely felt by ECRs working in QHR. Many studies stopped, almost overnight, as healthcare institutions restricted access and redeployed staff, forcing researchers to redesign or even abandon projects. We reflect on the burden of these challenges for insecurely employed QHR ECRs and discuss the approaches adopted to retain scientific integrity and redesign studies. We also highlight the impact of COVID-19 on career development and relationship building – both during the emergency pandemic period and in the reshaped context of academia that continues to operate under the long shadow of COVID-19. We conclude by outlining a programme of change for how the practice and organisation of QHR could be reshaped, identifying opportunities for learning from the pandemic. Embracing these learnings will benefit not only the careers and wellbeing of QHR ECRs, but also universities, funders and the overall health and future of QHR.

Research ethics in practice: An analysis of ethical issues encountered in qualitative health research with mental health service users and relatives

The ethics review of qualitative health research poses various challenges that are due to a mismatch between the current practice of ethics review and the nature of qualitative methodology. The process of obtaining ethics approval for a study by a research ethics committee before the start of a research study has been described as “procedural ethics” and the identification and handling of ethical issues by researchers during the research process as “ethics in practice.” While some authors dispute and other authors defend the use of procedural ethics in relation to qualitative health research, there is general agreement that it needs to be supplemented with ethics in practice. This article aims to provide an illustration of research ethics in practice by reflecting on the ways in which we identified and addressed ethical and methodological issues that arose in the context of an interview study with mental health service users and relatives. We describe the challenges we faced and the solutions we found in relation to the potential vulnerability of research participants, the voluntariness of consent, the increase of participant access and the heterogeneity of the sample, the protection of privacy and internal confidentiality, and the consideration of personal and contextual factors.

Drawing a River: Utilizing the Power of Metaphors in Interviews With Children and Young People.

In the field of qualitative health research on children, scholars have called for the inclusion of children's perspectives. Still, health care research on children appears to be characterized by an exclusionary approach that stems from a conception of disability and sickness as equivalent to a lack of agency. This article responds to the call to include children's perspectives. It presents the Double-view (Dovi)-river interview, which is a drawing- and metaphor-based interview method that enables ambiguous and multi-layered life course narratives. Based on two steps - (1) a life course interview conducted while drawing a river of the child's life and (2) revisiting and unfolding the child's stories - the method allows for an arts-based, joint exploration of life experiences. Inspired by childhood studies as well as a poststructuralist epistemology, the article discusses and proposes ways to challenge power relations between the adult interviewer and the child interviewee. It is argued that the method can also challenge the predominant deficit view and the dichotomous understanding of children's experiences of their life and capabilities that characterize much health care practice and health research, by focusing both on challenges and opportunities. Doing so enables a more nuanced and appreciative approach to children. We draw on empirical examples from a study with children with disabilities. However, we suggest that the method's potential for enabling articulation of the complex and ambiguous can inspire qualitative research and health care practice more broadly.

Research Ethics in Qualitative Health Research

Research Ethics in Qualitative Health Research

Reflections on qualitative research in global health: The practical complexities of crossing cultures, contexts, and languages.

Reflections on qualitative research in global health: The practical complexities of crossing cultures, contexts, and languages.

Dimensions of Researcher Vulnerability in Qualitative Health Research and Recommendations for Future Practice

Vulnerability has typically been addressed in the context of research ethics from the point of view of participants, with a focus on how to prevent the potential or exacerbation of existing harm caused by the power and role asymmetries between researchers and participants. However, more recent approaches to research ethics question whether researchers are, by definition, located in a privileged position during the research process and safe from any kind of vulnerability. In line with this, we reflect on the dimensions of researcher vulnerability specific to studies using a qualitative methodology in health research. Our argument is that participants and researchers should be on the receiving end of efforts to implement ethical procedures and protection from harm. Based on the autoethnographic analysis of our experiences as qualitative health researchers, this paper aims to identify dimensions of researcher vulnerability, and draw out relevant recommendations for practice. The reflections upon which this paper is based emerged during a spring school focusing on research ethics in qualitative health research, during which we discussed situations from our own research experience which left us feeling vulnerable. We identify four dimensions related to the experience of vulnerability (reciprocity; emotional labor; application of ethical standards; reversed power asymmetries) and five crosscutting aspects relating to these dimensions (researching sensitive topics; researching in contexts of vulnerability, poverty and structural violence; being a novice; lacking adequate support; insufficient time and space for ethical reflexivity). Our recommendations address particular challenges for these dimensions, and center on the role of reflexivity, as one of the cornerstones for enabling ethical qualitative research practice, requiring us to acknowledge and address our own vulnerability and positionality. Autoethnographic exercises are particularly useful for zooming in on ethically important moments in research related to researcher vulnerability and fruitful for identifying resources to respond to such challenges in the future.

Piloting a Flexible Solicited Diary Study With Marginalized Latina Women During the COVID-19 Pandemic.

Little is known about the experiences of minority stress among Latina women who have sex with both women and men (WSWM), a sexual and gender minority group situated at the intersection of multiple marginalized identities. The current article presents an exploratory study aimed at addressing this knowledge gap. The research utilized a flexible diary-interview method (DIM) to investigate stress-related experiences among Mexican American WSWM residing in an economically disadvantaged community in the U.S. during the third wave of the COVID-19 pandemic. A detailed description of the study is provided, including information on the background, methodology, participants' experiences, and how the project was managed remotely by a virtual research team. Twenty-one participants were asked to maintain a diary for a 6-week period spanning from March to September 2021. They submitted weekly entries in diverse formats (visual, audio, typed, and handwritten) through a user-friendly website or via mail while communicating regularly with researchers over the phone. Following the diarizing period, in-depth semi-structured interviews were conducted to clarify pertinent information within the entries and validate researchers' preliminary interpretations. Out of the initial 21 enrollees, 14 participants stopped diarizing at different stages, and nine completed the entire study. Despite facing challenges exacerbated by the pandemic, participants reported the diary-keeping process as a positive experience that offered an authentic outlet to share parts of their lives they seldom reveal. The implementation of this study highlights two significant methodological insights. Firstly, it emphasizes the value of employing a DIM to explore intersectional narratives. Secondly, it underscores the importance of adopting a flexible and sensitive approach in qualitative health research, particularly when engaging individuals from minoritized groups.

Qualitative analysis of barriers to precision oncology within the VHA.

e18760 Background: Rapidly expanding knowledge of molecular drivers of cancer helps facilitate effective, targeted cancer therapy (i.e. precision oncology), but research suggests that precision oncology is underused. We conducted a qualitative study of barriers and facilitators of precision oncology use within the Veterans Health Administration (VHA). Methods: We conducted a pragmatic qualitative study involving semi-structured interviews with both patients and providers at VA medical centers with low, medium, and high guideline concordant molecular testing. The interview guide was constructed by a multidisciplinary team of oncologists, qualitative health researchers and patient representatives using modified grounded theory (MGT) and the Theoretical Domains Framework (TDF). Summative and directed content analyses were conducted. Codes for the directed content analysis came from the framework and others evolved iteratively. Consensus-based approaches finalized the codebook. Results: Thirty-three interviews were conducted (17 patient and 16 provider interviews). A total of 1889 unique phrases were identified and categorized into 255 meaningful statement codes. The codes were mapped to 10 TDF domains. The most frequently cited determinants, representing 59% (1110 of 1889 statements) of all coded data, included the domains environmental context and resources, knowledge, and goals. Both patients and providers shared similar goals of improved outcomes and quality of care, but systems barriers were frequently cited impediments to precision oncology use. An additional 27% of codes (510 of 1889) represented the TDF domains of emotions (predominantly patient “fear of genetics” and confidence in providers), memory/attention (task priority in clinic visits), and interpersonal skills (both patient-provider, and interdisciplinary provider-provider). Additional frequently cited determinants, each comprising 6% of coded statements, included social influences (for both providers and patients) and reinforcement (perceived consequences). Conclusions: We identified determinants of precision oncology use at the patient, provider, and system level. Attempts to improve implementation of precision oncology will need to address systems barriers to care, as well as knowledge and patient-provider interactions, but can build on a foundation of shared goals.

Don't Get Caught in the Wrong Journal Trap: Insights for Young Researchers

This paper focuses on the importance of publishing research in indexed journals and the challenges encountered because of predatory publishers. This emphasizes the significance of qualitative health research and the use of evidence-based research approaches. The process of selecting indexed journals for publication is discussed, highlighting the benefits of credibility and recognition. The prevalence and detrimental consequences of predatory journals have been addressed, emphasizing the need for awareness and caution. The situation of scientific publication around the world is examined, noting the high presence of predatory journals and their impact on researchers' reputation and academic progress. Recommendations are provided to identify and avoid predatory journals as well as the need for increased education and accountability in the research community.

Concealed pregnancy as an act of care? A qualitative analysis of motivations for concealing and non-disclosure of early pregnancy in The Gambia

BackgroundA barrier to achieving first trimester antenatal care (ANC) attendance in many countries has been the widespread cultural practice of not discussing pregnancies in the early stages. Motivations for concealing pregnancy bear further study, as the interventions necessary to encourage early ANC attendance may be more complicated than targeting infrastructural barriers to ANC attendance such as transportation, time, and cost.MethodsFive focus groups with a total of 30 married, pregnant women were conducted to assess the feasibility of conducting a randomised controlled trial to evaluate the effectiveness of early initiation of physical activity and/or yoghurt consumption in reducing Gestational Diabetes Mellitus in pregnant women in The Gambia. Focus group transcripts were coded through a thematic analysis approach, assessing themes as they arose in relation to failure to attend early ANC.ResultsTwo reasons for the concealment of pregnancies in the first trimester or ahead of a pregnancy’s obvious visibility to others were given by focus group participants. These were ‘pregnancy outside of marriage’ and ‘evil spirits and miscarriage.’ Concealment on both grounds was motivated through specific worries and fears. In the case of a pregnancy outside of marriage, this was worry over social stigma and shame. Evil spirits were widely considered to be a cause of early miscarriage, and as such, women may choose to conceal their pregnancies in the early stages as a form of protection.ConclusionWomen’s lived experiences of evil spirits have been under-explored in qualitative health research as they relate specifically to women’s access to early antenatal care. Better understanding of how such sprits are experienced and why some women perceive themselves as vulnerable to related spiritual attacks may help healthcare workers or community health workers to identify in a timely manner the women most likely to fear such situations and spirits and subsequently conceal their pregnancies.

Using Communication Assistants in Qualitative Health Research.

Qualitative health research is hampered by narrow constructs of human communication that privilege participants with access to spoken and written (normative) language. With limited awareness of such things as augmentative and alternative communication (AAC) or the rights of people with complex communication access needs, qualitative research becomes a 'picker and chooser' of whose voices are included in studies and whose are not. In order for 'voices' to be heard, adaptations are required which include the acknowledgement and support of communication assistants (informal and formal) who can help provide a communication bridge between people with complex communication access needs and researcher(s). Yet little is known of who qualifies as a communication assistant nor the scope and limitations of this role in health research. Beginning with communication diversity arguments the article compares communication assistants with language interpreters before discussing practice and implications for health research.

Of Newcomers and Supervisors: Ethical Issues in Supervising Newcomers in Qualitative Health Research

This contribution focuses on our experiences as lecturers and supervisors in qualitative healthcare research in medicine, public health research and sociology, and the role of research ethics in guiding students in their qualitative studies. We argue that students themselves are vulnerable during the transition of becoming a qualitative researcher and that reflection on research is essential. Therefore, the selection of a topic, potential role conflicts and questions of field contingencies management become crucial elements in both teaching and researching. We use qualitative case vignettes, as suggested by Langer, to offer a reflective account of our experience. Protecting students from harm and preventing them from inadvertently causing harm to others are of utmost importance to us. Through these vignettes, we aim to provide a nuanced and reflective view of our experiences in supervising qualitative research.

Qualitative research in health: value and visibility

Qualitative research in health: value and visibility