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Qualitative research method-interviewing and observation

Shazia jamshed.

Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia

Buckley and Chiang define research methodology as “a strategy or architectural design by which the researcher maps out an approach to problem-finding or problem-solving.”[ 1 ] According to Crotty, research methodology is a comprehensive strategy ‘that silhouettes our choice and use of specific methods relating them to the anticipated outcomes,[ 2 ] but the choice of research methodology is based upon the type and features of the research problem.[ 3 ] According to Johnson et al . mixed method research is “a class of research where the researcher mixes or combines quantitative and qualitative research techniques, methods, approaches, theories and or language into a single study.[ 4 ] In order to have diverse opinions and views, qualitative findings need to be supplemented with quantitative results.[ 5 ] Therefore, these research methodologies are considered to be complementary to each other rather than incompatible to each other.[ 6 ]

Qualitative research methodology is considered to be suitable when the researcher or the investigator either investigates new field of study or intends to ascertain and theorize prominent issues.[ 6 , 7 ] There are many qualitative methods which are developed to have an in depth and extensive understanding of the issues by means of their textual interpretation and the most common types are interviewing and observation.[ 7 ]

Interviewing

This is the most common format of data collection in qualitative research. According to Oakley, qualitative interview is a type of framework in which the practices and standards be not only recorded, but also achieved, challenged and as well as reinforced.[ 8 ] As no research interview lacks structure[ 9 ] most of the qualitative research interviews are either semi-structured, lightly structured or in-depth.[ 9 ] Unstructured interviews are generally suggested in conducting long-term field work and allow respondents to let them express in their own ways and pace, with minimal hold on respondents’ responses.[ 10 ]

Pioneers of ethnography developed the use of unstructured interviews with local key informants that is., by collecting the data through observation and record field notes as well as to involve themselves with study participants. To be precise, unstructured interview resembles a conversation more than an interview and is always thought to be a “controlled conversation,” which is skewed towards the interests of the interviewer.[ 11 ] Non-directive interviews, form of unstructured interviews are aimed to gather in-depth information and usually do not have pre-planned set of questions.[ 11 ] Another type of the unstructured interview is the focused interview in which the interviewer is well aware of the respondent and in times of deviating away from the main issue the interviewer generally refocuses the respondent towards key subject.[ 11 ] Another type of the unstructured interview is an informal, conversational interview, based on unplanned set of questions that are generated instantaneously during the interview.[ 11 ]

In contrast, semi-structured interviews are those in-depth interviews where the respondents have to answer preset open-ended questions and thus are widely employed by different healthcare professionals in their research. Semi-structured, in-depth interviews are utilized extensively as interviewing format possibly with an individual or sometimes even with a group.[ 6 ] These types of interviews are conducted once only, with an individual or with a group and generally cover the duration of 30 min to more than an hour.[ 12 ] Semi-structured interviews are based on semi-structured interview guide, which is a schematic presentation of questions or topics and need to be explored by the interviewer.[ 12 ] To achieve optimum use of interview time, interview guides serve the useful purpose of exploring many respondents more systematically and comprehensively as well as to keep the interview focused on the desired line of action.[ 12 ] The questions in the interview guide comprise of the core question and many associated questions related to the central question, which in turn, improve further through pilot testing of the interview guide.[ 7 ] In order to have the interview data captured more effectively, recording of the interviews is considered an appropriate choice but sometimes a matter of controversy among the researcher and the respondent. Hand written notes during the interview are relatively unreliable, and the researcher might miss some key points. The recording of the interview makes it easier for the researcher to focus on the interview content and the verbal prompts and thus enables the transcriptionist to generate “verbatim transcript” of the interview.

Similarly, in focus groups, invited groups of people are interviewed in a discussion setting in the presence of the session moderator and generally these discussions last for 90 min.[ 7 ] Like every research technique having its own merits and demerits, group discussions have some intrinsic worth of expressing the opinions openly by the participants. On the contrary in these types of discussion settings, limited issues can be focused, and this may lead to the generation of fewer initiatives and suggestions about research topic.

Observation

Observation is a type of qualitative research method which not only included participant's observation, but also covered ethnography and research work in the field. In the observational research design, multiple study sites are involved. Observational data can be integrated as auxiliary or confirmatory research.[ 11 ]

Research can be visualized and perceived as painstaking methodical efforts to examine, investigate as well as restructure the realities, theories and applications. Research methods reflect the approach to tackling the research problem. Depending upon the need, research method could be either an amalgam of both qualitative and quantitative or qualitative or quantitative independently. By adopting qualitative methodology, a prospective researcher is going to fine-tune the pre-conceived notions as well as extrapolate the thought process, analyzing and estimating the issues from an in-depth perspective. This could be carried out by one-to-one interviews or as issue-directed discussions. Observational methods are, sometimes, supplemental means for corroborating research findings.

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Handbook of Research Methods in Health Social Sciences pp 391–410 Cite as

Qualitative Interviewing

  • Sally Nathan 2 ,
  • Christy Newman 3 &
  • Kari Lancaster 3  
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Qualitative interviewing is a foundational method in qualitative research and is widely used in health research and the social sciences. Both qualitative semi-structured and in-depth unstructured interviews use verbal communication, mostly in face-to-face interactions, to collect data about the attitudes, beliefs, and experiences of participants. Interviews are an accessible, often affordable, and effective method to understand the socially situated world of research participants. The approach is typically informed by an interpretive framework where the data collected is not viewed as evidence of the truth or reality of a situation or experience but rather a context-bound subjective insight from the participants. The researcher needs to be open to new insights and to privilege the participant’s experience in data collection. The data from qualitative interviews is not generalizable, but its exploratory nature permits the collection of rich data which can answer questions about which little is already known. This chapter introduces the reader to qualitative interviewing, the range of traditions within which interviewing is utilized as a method, and highlights the advantages and some of the challenges and misconceptions in its application. The chapter also provides practical guidance on planning and conducting interview studies. Three case examples are presented to highlight the benefits and risks in the use of interviewing with different participants, providing situated insights as well as advice about how to go about learning to interview if you are a novice.

  • In-depth interviews
  • Semi-structured interviews
  • Qualitative interviewing
  • Interview study design
  • Interview methodology
  • Interview method

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Nathan, S., Newman, C., Lancaster, K. (2019). Qualitative Interviewing. In: Liamputtong, P. (eds) Handbook of Research Methods in Health Social Sciences. Springer, Singapore. https://doi.org/10.1007/978-981-10-5251-4_77

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Textbooks, Guidebooks, and Handbooks  

  • The Ethnographic Interview by James P. Spradley  “Spradley wrote this book for the professional and student who have never done ethnographic fieldwork (p. 231) and for the professional ethnographer who is interested in adapting the author’s procedures (p. iv). Part 1 outlines in 3 chapters Spradley’s version of ethnographic research, and it provides the background for Part 2 which consists of 12 guided steps (chapters) ranging from locating and interviewing an informant to writing an ethnography. Most of the examples come from the author’s own fieldwork among U.S. subcultures . . . Steps 6 and 8 explain lucidly how to construct a domain and a taxonomic analysis” (excerpted from book review by James D. Sexton, 1980).  
  • Fundamentals of Qualitative Research by Johnny Saldana (Series edited by Patricia Leavy)  Provides a soup-to-nuts overview of the qualitative data collection process, including interviewing, participant observation, and other methods.  
  • InterViews by Steinar Kvale  Interviewing is an essential tool in qualitative research and this introduction to interviewing outlines both the theoretical underpinnings and the practical aspects of the process. After examining the role of the interview in the research process, Steinar Kvale considers some of the key philosophical issues relating to interviewing: the interview as conversation, hermeneutics, phenomenology, concerns about ethics as well as validity, and postmodernism. Having established this framework, the author then analyzes the seven stages of the interview process - from designing a study to writing it up.  
  • Practical Evaluation by Michael Quinn Patton  Surveys different interviewing strategies, from, a) informal/conversational, to b) interview guide approach, to c) standardized and open-ended, to d) closed/quantitative. Also discusses strategies for wording questions that are open-ended, clear, sensitive, and neutral, while supporting the speaker. Provides suggestions for probing and maintaining control of the interview process, as well as suggestions for recording and transcription.  
  • The SAGE Handbook of Interview Research by Amir B. Marvasti (Editor); James A. Holstein (Editor); Jaber F. Gubrium (Editor); Karyn D. McKinney (Editor)  The new edition of this landmark volume emphasizes the dynamic, interactional, and reflexive dimensions of the research interview. Contributors highlight the myriad dimensions of complexity that are emerging as researchers increasingly frame the interview as a communicative opportunity as much as a data-gathering format. The book begins with the history and conceptual transformations of the interview, which is followed by chapters that discuss the main components of interview practice. Taken together, the contributions to The SAGE Handbook of Interview Research: The Complexity of the Craft encourage readers simultaneously to learn the frameworks and technologies of interviewing and to reflect on the epistemological foundations of the interview craft.  
  • The SAGE Handbook of Online Research Methods by Nigel G. Fielding, Raymond M. Lee and Grant Blank (Editors) Bringing together the leading names in both qualitative and quantitative online research, this new edition is organised into nine sections: 1. Online Research Methods 2. Designing Online Research 3. Online Data Capture and Data Collection 4. The Online Survey 5. Digital Quantitative Analysis 6. Digital Text Analysis 7. Virtual Ethnography 8. Online Secondary Analysis: Resources and Methods 9. The Future of Online Social Research

ONLINE RESOURCES, COMMUNITIES, AND DATABASES  

  • Interviews as a Method for Qualitative Research (video) This short video summarizes why interviews can serve as useful data in qualitative research.  
  • Companion website to Bloomberg and Volpe's  Completing Your Qualitative Dissertation: A Road Map from Beginning to End,  4th ed Provides helpful templates and appendices featured in the book, as well as links to other useful dissertation resources.
  • International Congress of Qualitative Inquiry Annual conference hosted by the International Center for Qualitative Inquiry at the University of Illinois at Urbana-Champaign, which aims to facilitate the development of qualitative research methods across a wide variety of academic disciplines, among other initiatives.  
  • METHODSPACE ​​​​​​​​An online home of the research methods community, where practicing researchers share how to make research easier.  
  • SAGE researchmethods ​​​​​​​Researchers can explore methods concepts to help them design research projects, understand particular methods or identify a new method, conduct their research, and write up their findings. A "methods map" facilitates finding content on methods.

The decision to conduct interviews, and the type of interviewing to use, should flow from, or align with, the methodological paradigm chosen for your study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these).

Structured:

  • Structured Interview. Entry in The SAGE Encyclopedia of Social Science Research Methodsby Floyd J. Fowler Jr., Editors: Michael S. Lewis-Beck; Alan E. Bryman; Tim Futing Liao (Editor)  A concise article noting standards, procedures, and recommendations for developing and testing structured interviews. For an example of structured interview questions, you may view the Current Population Survey, May 2008: Public Participation in the Arts Supplement (ICPSR 29641), Apr 15, 2011 at https://doi.org/10.3886/ICPSR29641.v1 (To see the survey questions, preview the user guide, which can be found under the "Data and Documentation" tab. Then, look for page 177 (attachment 8).

Semi-Structured:

  • Semi-Structured Interview. Entry in The SAGE Encyclopedia of Qualitative Research Methodsby Lioness Ayres; Editor: Lisa M. Given  The semi-structured interview is a qualitative data collection strategy in which the researcher asks informants a series of predetermined but open-ended questions. The researcher has more control over the topics of the interview than in unstructured interviews, but in contrast to structured interviews or questionnaires that use closed questions, there is no fixed range of responses to each question.

Unstructured:

  • Unstructured Interview. Entry in The SAGE Encyclopedia of Qualitative Research Methodsby Michael W. Firmin; Editor: Lisa M. Given  Unstructured interviews in qualitative research involve asking relatively open-ended questions of research participants in order to discover their percepts on the topic of interest. Interviews, in general, are a foundational means of collecting data when using qualitative research methods. They are designed to draw from the interviewee constructs embedded in his or her thinking and rationale for decision making. The researcher uses an inductive method in data gathering, regardless of whether the interview method is open, structured, or semi-structured. That is, the researcher does not wish to superimpose his or her own viewpoints onto the person being interviewed. Rather, inductively, the researcher wishes to understand the participant's perceptions, helping him or her to articulate percepts such that they will be understood clearly by the journal reader.

Genres and Uses

Focus groups:.

  • "Focus Groups." Annual Review of Sociology 22 (1996): 129-1524.by David L. Morgan  Discusses the use of focus groups and group interviews as methods for gathering qualitative data used by sociologists and other academic and applied researchers. Focus groups are recommended for giving voice to marginalized groups and revealing the group effect on opinion formation.  
  • Qualitative Research Methods: A Data Collector's Field Guide (See Module 4: "Focus Groups")by Mack, N., et al.  This field guide is based on an approach to doing team-based, collaborative qualitative research that has repeatedly proven successful in research projects sponsored by Family Health International (FHI) throughout the developing world. With its straightforward delivery of information on the main qualitative methods being used in public health research today, the guide speaks to the need for simple yet effective instruction on how to do systematic and ethically sound qualitative research. The aim of the guide is thus practical. In bypassing extensive discussion on the theoretical underpinnings of qualitative research, it distinguishes itself as a how-to guide to be used in the field.

In-Depth (typically One-on-One):

  • A Practical Introduction to in-Depth Interviewingby Alan Morris  Are you new to qualitative research or a bit rusty and in need of some inspiration? Are you doing a research project involving in-depth interviews? Are you nervous about carrying out your interviews? This book will help you complete your qualitative research project by providing a nuts and bolts introduction to interviewing. With coverage of ethics, preparation strategies and advice for handling the unexpected in the field, this handy guide will help you get to grips with the basics of interviewing before embarking on your research. While recognising that your research question and the context of your research will drive your approach to interviewing, this book provides practical advice often skipped in traditional methods textbooks.  
  • Qualitative Research Methods: A Data Collector's Field Guide (See Module 3: "In-Depth Interviews")by Mack, N., et al.  This field guide is based on an approach to doing team-based, collaborative qualitative research that has repeatedly proven successful in research projects sponsored by Family Health International (FHI) throughout the developing world. With its straightforward delivery of information on the main qualitative methods being used in public health research today, the guide speaks to the need for simple yet effective instruction on how to do systematic and ethically sound qualitative research. The aim of the guide is thus practical. In bypassing extensive discussion on the theoretical underpinnings of qualitative research, it distinguishes itself as a how-to guide to be used in the field.

Folklore Research and Oral Histories:

In addition to the following resource, see the  Oral History   page of this guide for helpful resources on Oral History interviewing.

American Folklife Center at the Library of Congress. Folklife and Fieldwork: A Layman’s Introduction to Field Techniques Interviews gathered for purposes of folklore research are similar to standard social science interviews in some ways, but also have a good deal in common with oral history approaches to interviewing. The focus in a folklore research interview is on documenting and trying to understand the interviewee's way of life relative to a culture or subculture you are studying. This guide includes helpful advice and tips for conducting fieldwork in folklore, such as tips for planning, conducting, recording, and archiving interviews.

An interdisciplinary scientific program within the Institute for Quantitative Social Science which encourages and facilitates research and instruction in the theory and practice of survey research. The primary mission of PSR is to provide survey research resources to enhance the quality of teaching and research at Harvard.

  • Internet, Phone, Mail, and Mixed-Mode Surveysby Don A. Dillman; Jolene D. Smyth; Leah Melani Christian  The classic survey design reference, updated for the digital age. The new edition is thoroughly updated and revised, and covers all aspects of survey research. It features expanded coverage of mobile phones, tablets, and the use of do-it-yourself surveys, and Dillman's unique Tailored Design Method is also thoroughly explained. This new edition is complemented by copious examples within the text and accompanying website. It includes: Strategies and tactics for determining the needs of a given survey, how to design it, and how to effectively administer it. How and when to use mail, telephone, and Internet surveys to maximum advantage. Proven techniques to increase response rates. Guidance on how to obtain high-quality feedback from mail, electronic, and other self-administered surveys. Direction on how to construct effective questionnaires, including considerations of layout. The effects of sponsorship on the response rates of surveys. Use of capabilities provided by newly mass-used media: interactivity, presentation of aural and visual stimuli. The Fourth Edition reintroduces the telephone--including coordinating land and mobile.

User Experience (UX) and Marketing:

  • See the  "UX & Market Research Interviews"  tab on this guide, above. May include  Focus Groups,  above.

Screening for Research Site Selection:

  • Research interviews are used not only to furnish research data for theoretical analysis in the social sciences, but also to plan other kinds of studies. For example, interviews may allow researchers to screen appropriate research sites to conduct empirical studies (such as randomized controlled trials) in a variety of fields, from medicine to law. In contrast to interviews conducted in the course of social research, such interviews do not typically serve as the data for final analysis and publication.

ENGAGING PARTICIPANTS

Research ethics  .

  • Human Subjects (IRB) The Committee on the Use of Human Subjects (CUHS) serves as the Institutional Review Board for the University area which includes the Cambridge and Allston campuses at Harvard. Find your IRB  contact person , or learn about  required ethics training.  You may also find the  IRB Lifecycle Guide  helpful. This is the preferred IRB portal for Harvard graduate students and other researchers. IRB forms can be downloaded via the  ESTR Library  (click on the "Templates and Forms" tab, then navigate to pages 2 and 3 to find the documents labelled with “HUA” for the Harvard University Area IRB. Nota bene: You may use these forms only if you submit your study to the Harvard University IRB). The IRB office can be reached through email at [email protected] or by telephone at (617) 496-2847.  
  • Undergraduate Research Training Program (URTP) Portal The URTP at Harvard University is a comprehensive platform to create better prepared undergraduate researchers. The URTP is comprised of research ethics training sessions, a student-focused curriculum, and an online decision form that will assist students in determining whether their project requires IRB review. Students should examine the  URTP's guide for student researchers: Introduction to Human Subjects Research Protection.  
  • Ethics reports From the Association of Internet Researchers (AoIR)  
  • Respect, Beneficence, and Justice: QDR General Guidance for Human Participants If you are hoping to share your qualitative interview data in a repository after it has been collected, you will need to plan accordingly via informed consent, careful de-identification procedures, and data access controls. Consider  consulting with the Qualitative Research Support Group at Harvard Library  and consulting with  Harvard's Dataverse contacts  to help you think through all of the contingencies and processes.  
  • "Conducting a Qualitative Child Interview: Methodological Considerations." Journal of Advanced Nursing 42/5 (2003): 434-441 by Kortesluoma, R., et al.  The purpose of this article is to illustrate the theoretical premises of child interviewing, as well as to describe some practical methodological solutions used during interviews. Factors that influence data gathered from children and strategies for taking these factors into consideration during the interview are also described.  
  • "Crossing Cultural Barriers in Research Interviewing." Qualitative Social Work 63/3 (2007): 353-372 by Sands, R., et al.  This article critically examines a qualitative research interview in which cultural barriers between a white non-Muslim female interviewer and an African American Muslim interviewee, both from the USA, became evident and were overcome within the same interview.  
  • Decolonizing Methodologies: Research and Indigenous Peoples by Linda Tuhiwai Smith  This essential volume explores intersections of imperialism and research - specifically, the ways in which imperialism is embedded in disciplines of knowledge and tradition as 'regimes of truth.' Concepts such as 'discovery' and 'claiming' are discussed and an argument presented that the decolonization of research methods will help to reclaim control over indigenous ways of knowing and being. The text includes case-studies and examples, and sections on new indigenous literature and the role of research in indigenous struggles for social justice.  

This resource, sponsored by University of Oregon Libraries, exemplifies the use of interviewing methodologies in research that foregrounds traditional knowledge. The methodology page summarizes the approach.

  • Ethics: The Need to Tread Carefully. Chapter in A Practical Introduction to in-Depth Interviewing by Alan Morris  Pay special attention to the sections in chapter 2 on "How to prevent and respond to ethical issues arising in the course of the interview," "Ethics in the writing up of your interviews," and "The Ethics of Care."  
  • Handbook on Ethical Issues in Anthropology by Joan Cassell (Editor); Sue-Ellen Jacobs (Editor)  This publication of the American Anthropological Association presents and discusses issues and sources on ethics in anthropology, as well as realistic case studies of ethical dilemmas. It is meant to help social science faculty introduce discussions of ethics in their courses. Some of the topics are relevant to interviews, or at least to studies of which interviews are a part. See chapters 3 and 4 for cases, with solutions and commentary, respectively.  
  • Research Ethics from the Chanie Wenjack School for Indigenous Studies, Trent University  (Open Access) An overview of Indigenous research ethics and protocols from the across the globe.  
  • Resources for Equity in Research Consult these resources for guidance on creating and incorporating equitable materials into public health research studies that entail community engagement.

The SAGE Handbook of Qualitative Research Ethics by Ron Iphofen (Editor); Martin Tolich (Editor)  This handbook is a much-needed and in-depth review of the distinctive set of ethical considerations which accompanies qualitative research. This is particularly crucial given the emergent, dynamic and interactional nature of most qualitative research, which too often allows little time for reflection on the important ethical responsibilities and obligations. Contributions from leading international researchers have been carefully organized into six key thematic sections: Part One: Thick Descriptions Of Qualitative Research Ethics; Part Two: Qualitative Research Ethics By Technique; Part Three: Ethics As Politics; Part Four: Qualitative Research Ethics With Vulnerable Groups; Part Five: Relational Research Ethics; Part Six: Researching Digitally. This Handbook is a one-stop resource on qualitative research ethics across the social sciences that draws on the lessons learned and the successful methods for surmounting problems - the tried and true, and the new.

RESEARCH COMPLIANCE AND PRIVACY LAWS

Research Compliance Program for FAS/SEAS at Harvard : The Faculty of Arts and Sciences (FAS), including the School of Engineering and Applied Sciences (SEAS), and the Office of the Vice Provost for Research (OVPR) have established a shared Research Compliance Program (RCP). An area of common concern for interview studies is international projects and collaboration . RCP is a resource to provide guidance on which international activities may be impacted by US sanctions on countries, individuals, or entities and whether licenses or other disclosure are required to ship or otherwise share items, technology, or data with foreign collaborators.

  • Harvard Global Support Services (GSS) is for students, faculty, staff, and researchers who are studying, researching, or working abroad. Their services span safety and security, health, culture, outbound immigration, employment, financial and legal matters, and research center operations. These include travel briefings and registration, emergency response, guidance on international projects, and managing in-country operations.

Generative AI: Harvard-affiliated researchers should not enter data classified as confidential ( Level 2 and above ), including non-public research data, into publicly-available generative AI tools, in accordance with the University’s Information Security Policy. Information shared with generative AI tools using default settings is not private and could expose proprietary or sensitive information to unauthorized parties.

Privacy Laws: Be mindful of any potential privacy laws that may apply wherever you conduct your interviews. The General Data Protection Regulation is a high-profile example (see below):

  • General Data Protection Regulation (GDPR) This Regulation lays down rules relating to the protection of natural persons with regard to the processing of personal data and rules relating to the free movement of personal data. It protects fundamental rights and freedoms of natural persons and in particular their right to the protection of personal data. The free movement of personal data within the Union shall be neither restricted nor prohibited for reasons connected with the protection of natural persons with regard to the processing of personal data. For a nice summary of what the GDPR requires, check out the GDPR "crash course" here .

SEEKING CONSENT  

If you would like to see examples of consent forms, ask your local IRB, or take a look at these resources:

  • Model consent forms for oral history, suggested by the Centre for Oral History and Digital Storytelling at Concordia University  
  • For NIH-funded research, see this  resource for developing informed consent language in research studies where data and/or biospecimens will be stored and shared for future use.

POPULATION SAMPLING

If you wish to assemble resources to aid in sampling, such as the USPS Delivery Sequence File, telephone books, or directories of organizations and listservs, please contact our  data librarian  or write to  [email protected] .

  • Research Randomizer   A free web-based service that permits instant random sampling and random assignment. It also contains an interactive tutorial perfect for students taking courses in research methods.  
  • Practical Tools for Designing and Weighting Survey Samples by Richard Valliant; Jill A. Dever; Frauke Kreuter  Survey sampling is fundamentally an applied field. The goal in this book is to put an array of tools at the fingertips of practitioners by explaining approaches long used by survey statisticians, illustrating how existing software can be used to solve survey problems, and developing some specialized software where needed. This book serves at least three audiences: (1) Students seeking a more in-depth understanding of applied sampling either through a second semester-long course or by way of a supplementary reference; (2) Survey statisticians searching for practical guidance on how to apply concepts learned in theoretical or applied sampling courses; and (3) Social scientists and other survey practitioners who desire insight into the statistical thinking and steps taken to design, select, and weight random survey samples. Several survey data sets are used to illustrate how to design samples, to make estimates from complex surveys for use in optimizing the sample allocation, and to calculate weights. Realistic survey projects are used to demonstrate the challenges and provide a context for the solutions. The book covers several topics that either are not included or are dealt with in a limited way in other texts. These areas include: sample size computations for multistage designs; power calculations related to surveys; mathematical programming for sample allocation in a multi-criteria optimization setting; nuts and bolts of area probability sampling; multiphase designs; quality control of survey operations; and statistical software for survey sampling and estimation. An associated R package, PracTools, contains a number of specialized functions for sample size and other calculations. The data sets used in the book are also available in PracTools, so that the reader may replicate the examples or perform further analyses.  
  • Sampling: Design and Analysis by Sharon L. Lohr  Provides a modern introduction to the field of sampling. With a multitude of applications from a variety of disciplines, the book concentrates on the statistical aspects of taking and analyzing a sample. Overall, the book gives guidance on how to tell when a sample is valid or not, and how to design and analyze many different forms of sample surveys.  
  • Sampling Techniques by William G. Cochran  Clearly demonstrates a wide range of sampling methods now in use by governments, in business, market and operations research, social science, medicine, public health, agriculture, and accounting. Gives proofs of all the theoretical results used in modern sampling practice. New topics in this edition include the approximate methods developed for the problem of attaching standard errors or confidence limits to nonlinear estimates made from the results of surveys with complex plans.  
  • "Understanding the Process of Qualitative Data Collection" in Chapter 13 (pp. 103–1162) of 30 Essential Skills for the Qualitative Researcher by John W. Creswell  Provides practical "how-to" information for beginning researchers in the social, behavioral, and health sciences with many applied examples from research design, qualitative inquiry, and mixed methods.The skills presented in this book are crucial for a new qualitative researcher starting a qualitative project.  
  • Survey Methodology by Robert M. Groves; Floyd J. Fowler; Mick P. Couper; James M. Lepkowski; Eleanor Singer; Roger Tourangeau; Floyd J. Fowler  coverage includes sampling frame evaluation, sample design, development of questionnaires, evaluation of questions, alternative modes of data collection, interviewing, nonresponse, post-collection processing of survey data, and practices for maintaining scientific integrity.

The way a qualitative researcher constructs and approaches interview questions should flow from, or align with, the methodological paradigm chosen for the study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these).

Constructing Your Questions

Helpful texts:.

  • "Developing Questions" in Chapter 4 (pp. 98–108) of Becoming Qualitative Researchers by Corrine Glesne  Ideal for introducing the novice researcher to the theory and practice of qualitative research, this text opens students to the diverse possibilities within this inquiry approach, while helping them understand how to design and implement specific research methods.  
  • "Learning to Interview in the Social Sciences" Qualitative Inquiry, 9(4) 2003, 643–668 by Roulston, K., deMarrais, K., & Lewis, J. B. See especially the section on "Phrasing and Negotiating Questions" on pages 653-655 and common problems with framing questions noted on pages 659 - 660.  
  • Qualitative Research Interviewing: Biographic Narrative and Semi-Structured Methods (See sections on “Lightly and Heavily Structured Depth Interviewing: Theory-Questions and Interviewer-Questions” and “Preparing for any Interviewing Sequence") by Tom Wengraf  Unique in its conceptual coherence and the level of practical detail, this book provides a comprehensive resource for those concerned with the practice of semi-structured interviewing, the most commonly used interview approach in social research, and in particular for in-depth, biographic narrative interviewing. It covers the full range of practices from the identification of topics through to strategies for writing up research findings in diverse ways.  
  • "Scripting a Qualitative Purpose Statement and Research Questions" in Chapter 12 (pp. 93–102) of 30 Essential Skills for the Qualitative Researcher by John W. Creswell  Provides practical "how-to" information for beginning researchers in the social, behavioral, and health sciences with many applied examples from research design, qualitative inquiry, and mixed methods.The skills presented in this book are crucial for a new qualitative researcher starting a qualitative project.  
  • Some Strategies for Developing Interview Guides for Qualitative Interviews by Sociology Department, Harvard University Includes general advice for conducting qualitative interviews, pros and cons of recording and transcription, guidelines for success, and tips for developing and phrasing effective interview questions.  
  • Tip Sheet on Question Wording by Harvard University Program on Survey Research

Let Theory Guide You:

The quality of your questions depends on how you situate them within a wider body of knowledge. Consider the following advice:

A good literature review has many obvious virtues. It enables the investigator to define problems and assess data. It provides the concepts on which percepts depend. But the literature review has a special importance for the qualitative researcher. This consists of its ability to sharpen his or her capacity for surprise (Lazarsfeld, 1972b). The investigator who is well versed in the literature now has a set of expectations the data can defy. Counterexpectational data are conspicuous, readable, and highly provocative data. They signal the existence of unfulfilled theoretical assumptions, and these are, as Kuhn (1962) has noted, the very origins of intellectual innovation. A thorough review of the literature is, to this extent, a way to manufacture distance. It is a way to let the data of one's research project take issue with the theory of one's field.

McCracken, G. (1988), The Long Interview, Sage: Newbury Park, CA, p. 31

When drafting your interview questions, remember that everything follows from your central research question. Also, on the way to writing your "operationalized" interview questions, it's  helpful to draft broader, intermediate questions, couched in theory. Nota bene:  While it is important to know the literature well before conducting your interview(s), be careful not to present yourself to your research participant(s) as "the expert," which would be presumptuous and could be intimidating. Rather, the purpose of your knowledge is to make you a better, keener listener.

If you'd like to supplement what you learned about relevant theories through your coursework and literature review, try these sources:

  • Annual Reviews   Review articles sum up the latest research in many fields, including social sciences, biomedicine, life sciences, and physical sciences. These are timely collections of critical reviews written by leading scientists.  
  • HOLLIS - search for resources on theories in your field   Modify this example search by entering the name of your field in place of "your discipline," then hit search.  
  • Oxford Bibliographies   Written and reviewed by academic experts, every article in this database is an authoritative guide to the current scholarship in a variety of fields, containing original commentary and annotations.  
  • ProQuest Dissertations & Theses (PQDT)   Indexes dissertations and masters' theses from most North American graduate schools as well as some European universities. Provides full text for most indexed dissertations from 1990-present.  
  • Very Short Introductions   Launched by Oxford University Press in 1995, Very Short Introductions offer concise introductions to a diverse range of subjects from Climate to Consciousness, Game Theory to Ancient Warfare, Privacy to Islamic History, Economics to Literary Theory.

CONDUCTING INTERVIEWS

Equipment and software:  .

  • Lamont Library  loans microphones and podcast starter kits, which will allow you to capture audio (and you may record with software, such as Garage Band). 
  • Cabot Library  loans digital recording devices, as well as USB microphones.

If you prefer to use your own device, you may purchase a small handheld audio recorder, or use your cell phone.

  • Audio Capture Basics (PDF)  - Helpful instructions, courtesy of the Lamont Library Multimedia Lab.
  • Getting Started with Podcasting/Audio:  Guidelines from Harvard Library's Virtual Media Lab for preparing your interviewee for a web-based recording (e.g., podcast, interview)
  • ​ Camtasia Screen Recorder and Video Editor
  • Zoom: Video Conferencing, Web Conferencing
  • Visit the Multimedia Production Resources guide! Consult it to find and learn how to use audiovisual production tools, including: cameras, microphones, studio spaces, and other equipment at Cabot Science Library and Lamont Library.
  • Try the virtual office hours offered by the Lamont Multimedia Lab!

TIPS FOR CONDUCTING INTERVIEWS

Quick handout:  .

  • Research Interviewing Tips (Courtesy of Dr. Suzanne Spreadbury)

Remote Interviews:  

  • For Online or Distant Interviews, See "Remote Research & Virtual Fieldwork" on this guide .  
  • Deborah Lupton's Bibliography: Doing Fieldwork in a Pandemic

Seeking Consent:

Books and articles:  .

  • "App-Based Textual Interviews: Interacting With Younger Generations in a Digitalized Social Reallity."International Journal of Social Research Methodology (12 June 2022). Discusses the use of texting platforms as a means to reach young people. Recommends useful question formulations for this medium.  
  • "Learning to Interview in the Social Sciences." Qualitative Inquiry, 9(4) 2003, 643–668 by Roulston, K., deMarrais, K., & Lewis, J. B. See especially the section on "Phrasing and Negotiating Questions" on pages 653-655 and common problems with framing questions noted on pages 659-660.  
  • "Slowing Down and Digging Deep: Teaching Students to Examine Interview Interaction in Depth." LEARNing Landscapes, Spring 2021 14(1) 153-169 by Herron, Brigette A. and Kathryn Roulston. Suggests analysis of videorecorded interviews as a precursor to formulating one's own questions. Includes helpful types of probes.  
  • Using Interviews in a Research Project by Nigel Joseph Mathers; Nicholas J Fox; Amanda Hunn; Trent Focus Group.  A work pack to guide researchers in developing interviews in the healthcare field. Describes interview structures, compares face-to-face and telephone interviews. Outlines the ways in which different types of interview data can be analysed.  
  • “Working through Challenges in Doing Interview Research.” International Journal of Qualitative Methods, (December 2011), 348–66 by Roulston, Kathryn.  The article explores (1) how problematic interactions identified in the analysis of focus group data can lead to modifications in research design, (2) an approach to dealing with reported data in representations of findings, and (3) how data analysis can inform question formulation in successive rounds of data generation. Findings from these types of examinations of interview data generation and analysis are valuable for informing both interview practice as well as research design.

Videos:  

video still image

The way a qualitative researcher transcribes interviews should flow from, or align with, the methodological paradigm chosen for the study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these).

TRANSCRIPTION

Before embarking on a transcription project, it's worthwhile to invest in the time and effort necessary to capture good audio, which will make the transcription process much easier. If you haven't already done so, check out the  audio capture guidelines from Harvard Library's Virtual Media Lab , or  contact a media staff member  for customized recommendations. First and foremost, be mindful of common pitfalls by watching this short video that identifies  the most common errors to avoid!

SOFTWARE:  

  • Otter  provides a new way to capture, store, search and share voice conversations, lectures, presentations, meetings, and interviews. The startup is based in Silicon Valley with a team of experienced Ph.Ds and engineers from Google, Facebook, Yahoo and Nuance (à la Dragon). Free accounts available. This is the software that  Zoom  uses to generate automated transcripts, so if you have access to a Zoom subscription, you have access to Otter transcriptions with it (applicable in several  languages ). As with any automated approach, be prepared to correct any errors after the fact, by hand.  
  • Panopto  is available to Harvard affiliates and generates  ASR (automated speech recognition) captions . You may upload compatible audio files into it. As with any automatically generated transcription, you will need to make manual revisions. ASR captioning is available in several  languages .  
  • GoTranscript  provides cost-effective human-generated transcriptions.  
  • pyTranscriber  is an app for generating automatic transcription and/or subtitles for audio and video files. It uses the Google Cloud Speech-to-Text service, has a friendly graphical user interface, and is purported to work nicely with Chinese.   
  • REV.Com  allows you to record and transcribe any calls on the iPhone, both outgoing and incoming. It may be useful for recording phone interviews. Rev lets you choose whether you want an AI- or human-generated transcription, with a fast turnaround.  
  • Scribie Audio/Video Transcription  provides automated or manual transcriptions for a small fee. As with any transcription service, some revisions will be necessary after the fact, particularly for its automated transcripts.  
  • Sonix  automatically transcribes, translates, and helps to organize audio and video files in over 40 languages. It's fast and affordable, with good accuracy. The free trial includes 30 minutes of free transcription.  
  • TranscriptionWing  uses a human touch process to clean up machine-generated transcripts so that the content will far more accurately reflect your audio recording. 

EQUIPMENT:  

  • Transcription pedals  are in circulation and available to borrow from the Circulation desk at Lamont, or use at Lamont Library's Media Lab on level B. For hand-transcribing your interviews, they work in conjunction with software such as  Express Scribe , which is loaded on Media Lab computers, or you may download for free on your own machine (Mac or PC versions; scroll down the downloads page for the latter). The pedals are plug-and-play USB, allow a wide range of playback speeds, and have 3 programmable buttons, which are typically set to rewind/play/fast-forward. Instructions are included in the bag that covers installation and set-up of the software, and basic use of the pedals.

NEED HELP?  

  • Try the virtual office hours offered by the Lamont Multimedia Lab!    
  • If you're creating podcasts, login to  Canvas  and check out the  Podcasting/Audio guide . 

Helpful Texts:  

  • "Transcription as a Crucial Step of Data Analysis" in Chapter 5 of The SAGE Handbook of Qualitative Data Analysisby Uwe Flick (Editor)  Covers basic terminology for transcription, shares caveats for transcribers, and identifies components of vocal behavior. Provides notation systems for transcription, suggestions for transcribing turn-taking, and discusses new technologies and perspectives. Includes a bibliography for further reading.  
  • "Transcribing the Oral Interview: Part Art, Part Science " on p. 10 of the Centre for Community Knowledge (CCK) newsletter: TIMESTAMPby Mishika Chauhan and Saransh Srivastav

QUALITATIVE DATA ANALYSIS

Software  .

  • Free download available for Harvard Faculty of Arts and Sciences (FAS) affiliates
  • Desktop access at Lamont Library Media Lab, 3rd floor
  • Desktop access at Harvard Kennedy School Library (with HKS ID)
  • Remote desktop access for Harvard affiliates from  IQSS Computer Labs . Email them at  [email protected] and ask for a new lab account and remote desktop access to NVivo.
  • Virtual Desktop Infrastructure (VDI) access available to Harvard T.H. Chan School of Public Health affiliates

CODING AND THEMEING YOUR DATA

Data analysis methods should flow from, or align with, the methodological paradigm chosen for your study, whether that paradigm is interpretivist, critical, positivist, or participative in nature (or a combination of these). Some established methods include Content Analysis, Critical Analysis, Discourse Analysis, Gestalt Analysis, Grounded Theory Analysis, Interpretive Analysis, Narrative Analysis, Normative Analysis, Phenomenological Analysis, Rhetorical Analysis, and Semiotic Analysis, among others. The following resources should help you navigate your methodological options and put into practice methods for coding, themeing, interpreting, and presenting your data.

  • Users can browse content by topic, discipline, or format type (reference works, book chapters, definitions, etc.). SRM offers several research tools as well: a methods map, user-created reading lists, a project planner, and advice on choosing statistical tests.  
  • Abductive Coding: Theory Building and Qualitative (Re)Analysis by Vila-Henninger, et al.  The authors recommend an abductive approach to guide qualitative researchers who are oriented towards theory-building. They outline a set of tactics for abductive analysis, including the generation of an abductive codebook, abductive data reduction through code equations, and in-depth abductive qualitative analysis.  
  • Analyzing and Interpreting Qualitative Research: After the Interview by Charles F. Vanover, Paul A. Mihas, and Johnny Saldana (Editors)   Providing insight into the wide range of approaches available to the qualitative researcher and covering all steps in the research process, the authors utilize a consistent chapter structure that provides novice and seasoned researchers with pragmatic, "how-to" strategies. Each chapter author introduces the method, uses one of their own research projects as a case study of the method described, shows how the specific analytic method can be used in other types of studies, and concludes with three questions/activities to prompt class discussion or personal study.   
  • "Analyzing Qualitative Data." Theory Into Practice 39, no. 3 (2000): 146-54 by Margaret D. LeCompte   This article walks readers though rules for unbiased data analysis and provides guidance for getting organized, finding items, creating stable sets of items, creating patterns, assembling structures, and conducting data validity checks.  
  • "Coding is Not a Dirty Word" in Chapter 1 (pp. 1–30) of Enhancing Qualitative and Mixed Methods Research with Technology by Shalin Hai-Jew (Editor)   Current discourses in qualitative research, especially those situated in postmodernism, represent coding and the technology that assists with coding as reductive, lacking complexity, and detached from theory. In this chapter, the author presents a counter-narrative to this dominant discourse in qualitative research. The author argues that coding is not necessarily devoid of theory, nor does the use of software for data management and analysis automatically render scholarship theoretically lightweight or barren. A lack of deep analytical insight is a consequence not of software but of epistemology. Using examples informed by interpretive and critical approaches, the author demonstrates how NVivo can provide an effective tool for data management and analysis. The author also highlights ideas for critical and deconstructive approaches in qualitative inquiry while using NVivo. By troubling the positivist discourse of coding, the author seeks to create dialogic spaces that integrate theory with technology-driven data management and analysis, while maintaining the depth and rigor of qualitative research.   
  • The Coding Manual for Qualitative Researchers by Johnny Saldana   An in-depth guide to the multiple approaches available for coding qualitative data. Clear, practical and authoritative, the book profiles 32 coding methods that can be applied to a range of research genres from grounded theory to phenomenology to narrative inquiry. For each approach, Saldaña discusses the methods, origins, a description of the method, practical applications, and a clearly illustrated example with analytic follow-up. Essential reading across the social sciences.  
  • Flexible Coding of In-depth Interviews: A Twenty-first-century Approach by Nicole M. Deterding and Mary C. Waters The authors suggest steps in data organization and analysis to better utilize qualitative data analysis technologies and support rigorous, transparent, and flexible analysis of in-depth interview data.  
  • From the Editors: What Grounded Theory is Not by Roy Suddaby Walks readers through common misconceptions that hinder grounded theory studies, reinforcing the two key concepts of the grounded theory approach: (1) constant comparison of data gathered throughout the data collection process and (2) the determination of which kinds of data to sample in succession based on emergent themes (i.e., "theoretical sampling").  
  • “Good enough” methods for life-story analysis, by Wendy Luttrell. In Quinn N. (Ed.), Finding culture in talk (pp. 243–268). Demonstrates for researchers of culture and consciousness who use narrative how to concretely document reflexive processes in terms of where, how and why particular decisions are made at particular stages of the research process.   
  • Presentation slides on coding and themeing your data, derived from Saldana, Spradley, and LeCompte Click to request access.  
  • Qualitative Data Analysis by Matthew B. Miles; A. Michael Huberman   A practical sourcebook for researchers who make use of qualitative data, presenting the current state of the craft in the design, testing, and use of qualitative analysis methods. Strong emphasis is placed on data displays matrices and networks that go beyond ordinary narrative text. Each method of data display and analysis is described and illustrated.  
  • "A Survey of Qualitative Data Analytic Methods" in Chapter 4 (pp. 89–138) of Fundamentals of Qualitative Research by Johnny Saldana   Provides an in-depth introduction to coding as a heuristic, particularly focusing on process coding, in vivo coding, descriptive coding, values coding, dramaturgical coding, and versus coding. Includes advice on writing analytic memos, developing categories, and themeing data.   
  • "Thematic Networks: An Analytic Tool for Qualitative Research." Qualitative Research : QR, 1(3), 385–405 by Jennifer Attride-Stirling Details a technique for conducting thematic analysis of qualitative material, presenting a step-by-step guide of the analytic process, with the aid of an empirical example. The analytic method presented employs established, well-known techniques; the article proposes that thematic analyses can be usefully aided by and presented as thematic networks.  
  • Using Thematic Analysis in Psychology by Virginia Braun and Victoria Clark Walks readers through the process of reflexive thematic analysis, step by step. The method may be adapted in fields outside of psychology as relevant. Pair this with One Size Fits All? What Counts as Quality Practice in Reflexive Thematic Analysis? by Virginia Braun and Victoria Clark

TESTING OR GENERATING THEORIES

The quality of your data analysis depends on how you situate what you learn within a wider body of knowledge. Consider the following advice:

Once you have coalesced around a theory, realize that a theory should  reveal  rather than  color  your discoveries. Allow your data to guide you to what's most suitable. Grounded theory  researchers may develop their own theory where current theories fail to provide insight.  This guide on Theoretical Models  from Alfaisal University Library provides a helpful overview on using theory.

MANAGING & FINDING INTERVIEW DATA

Managing your elicited interview data, help with securing, storing, and sharing it:  .

  • Research Data Management @ Harvard A reference guide with information and resources to help you manage your research data. See also: Harvard Research Data Security Policy , on the Harvard University Research Data Management website.  
  • Harvard's Best Practices for Protecting Privacy and  Harvard Information Security Collaboration Tools Matrix Follow the nuts-and-bolts advice for privacy best practices at Harvard. The latter resource reveals the level of security that can be relied upon for a large number of technological tools and platforms used at Harvard to conduct business, such as email, Slack, Accellion Kiteworks, OneDrive/SharePoint, etc.  
  • Harvard Data Classification Table This resource provided by Harvard Data Security helps you determine what level of access is appropriate for your data. Determine whether it should be made available for public use, limited to the Harvard community, or be protected as either "confidential and sensitive," "high risk," or "extremely sensitive."  
  • Harvard Information Security Quick Reference Guide Storage guidelines, based on the data's security classification level (according to its IRB classification) is displayed on page 2, under "handling."  
  • Email Encryption Harvard Microsoft 365 users can now send encrypted messages and files directly from the Outlook web or desktop apps. Encrypting an email adds an extra layer of security to the message and its attachments (up to 150MB), and means only the intended recipient (and their inbox delegates with full access) can view it. Message encryption in Outlook is approved for sending high risk ( level 4 ) data and below.  
  • Generative AI Harvard-affiliated researchers should not enter data classified as confidential ( Level 2 and above ), including non-public research data, into publicly-available generative AI tools, in accordance with the University’s Information Security Policy. Information shared with generative AI tools using default settings is not private and could expose proprietary or sensitive information to unauthorized parties.  
  • Repositories for Qualitative Data If you have cleared this intention with your IRB, secured consent from participants, and properly de-identified your data, consider sharing your interviews in one of the data repositories included in the link above. Depending on the nature of your research and the level of risk it may present to participants, sharing your interview data may not be appropriate. If there is any chance that sharing such data will be desirable, you will be much better off if you build this expectation into your plans from the beginning.  
  • Research Compliance Program for FAS/SEAS at Harvard The Faculty of Arts and Sciences (FAS), including the School of Engineering and Applied Sciences (SEAS), and the Office of the Vice Provost for Research (OVPR) have established a shared Research Compliance Program (RCP). An area of common concern for interview studies is international projects and collaboration . RCP is a resource to provide guidance on which international activities may be impacted by US sanctions on countries, individuals, or entities and whether licenses or other disclosure are required to ship or otherwise share items, technology, or data with foreign collaborators.

Finding Extant Interview Data

Finding journalistic interviews:  .

  • Academic Search Premier This all-purpose database is great for finding articles from magazines and newspapers. In the Advanced Search, it allows you to specify "Document Type":  Interview.  
  • Guide to Newspapers and Newspaper Indexes Use this guide created to Harvard Librarians to identify newspapers collections you'd like to search. To locate interviews, try adding the term  "interview"  to your search, or explore a database's search interface for options to  limit your search to interviews.  Nexis Uni  and  Factiva  are the two main databases for current news.   
  • Listen Notes Search for podcast episodes at this podcast aggregator, and look for podcasts that include interviews. Make sure to vet the podcaster for accuracy and quality! (Listen Notes does not do much vetting.)  
  • NPR  and  ProPublica  are two sites that offer high-quality long-form reporting, including journalistic interviews, for free.

Finding Oral History and Social Research Interviews:  

  • To find oral histories, see the Oral History   page of this guide for helpful resources on Oral History interviewing.  
  • Repositories for Qualitative Data It has not been a customary practice among qualitative researchers in the social sciences to share raw interview data, but some have made this data available in repositories, such as the ones listed on the page linked above. You may find published data from structured interview surveys (e.g., questionnaire-based computer-assisted telephone interview data), as well as some semi-structured and unstructured interviews.  
  • If you are merely interested in studies interpreting data collected using interviews, rather than finding raw interview data, try databases like  PsycInfo ,  Sociological Abstracts , or  Anthropology Plus , among others. 

Finding Interviews in Archival Collections at Harvard Library:

In addition to the databases and search strategies mentioned under the  "Finding Oral History and Social Research Interviews" category above,  you may search for interviews and oral histories (whether in textual or audiovisual formats) held in archival collections at Harvard Library.

  • HOLLIS searches all documented collections at Harvard, whereas HOLLIS for Archival Discovery searches only those with finding aids. Although HOLLIS for Archival Discovery covers less material, you may find it easier to parse your search results, especially when you wish to view results at the item level (within collections). Try these approaches:

Search in  HOLLIS :  

  • To retrieve items available online, do an Advanced Search for  interview* OR "oral histor*" (in Subject), with Resource Type "Archives/Manuscripts," then refine your search by selecting "Online" under "Show Only" on the right of your initial result list.  Revise the search above by adding your topic in the Keywords or Subject field (for example:  African Americans ) and resubmitting the search.  
  •  To enlarge your results set, you may also leave out the "Online" refinement; if you'd like to limit your search to a specific repository, try the technique of searching for  Code: Library + Collection on the "Advanced Search" page .   

Search in  HOLLIS for Archival Discovery :  

  • To retrieve items available online, search for   interview* OR "oral histor*" limited to digital materials . Revise the search above by adding your topic (for example:  artist* ) in the second search box (if you don't see the box, click +).  
  • To preview results by collection, search for  interview* OR "oral histor*" limited to collections . Revise the search above by adding your topic (for example:  artist* ) in the second search box (if you don't see the box, click +). Although this method does not allow you to isolate digitized content, you may find the refinement options on the right side of the screen (refine by repository, subject or names) helpful.  Once your select a given collection, you may search within it  (e.g., for your topic or the term interview).

UX & MARKET RESEARCH INTERVIEWS

Ux at harvard library  .

  • User Experience and Market Research interviews can inform the design of tangible products and services through responsive, outcome-driven insights. The  User Research Center  at Harvard Library specializes in this kind of user-centered design, digital accessibility, and testing. They also offer guidance and  resources  to members of the Harvard Community who are interested in learning more about UX methods. Contact [email protected] or consult the URC website for more information.

Websites  

  • User Interviews: The Beginner’s Guide (Chris Mears)  
  • Interviewing Users (Jakob Nielsen)

Books  

  • Interviewing Users: How to Uncover Compelling Insights by Steve Portigal; Grant McCracken (Foreword by)  Interviewing is a foundational user research tool that people assume they already possess. Everyone can ask questions, right? Unfortunately, that's not the case. Interviewing Users provides invaluable interviewing techniques and tools that enable you to conduct informative interviews with anyone. You'll move from simply gathering data to uncovering powerful insights about people.  
  • Rapid Contextual Design by Jessamyn Wendell; Karen Holtzblatt; Shelley Wood  This handbook introduces Rapid CD, a fast-paced, adaptive form of Contextual Design. Rapid CD is a hands-on guide for anyone who needs practical guidance on how to use the Contextual Design process and adapt it to tactical projects with tight timelines and resources. Rapid Contextual Design provides detailed suggestions on structuring the project and customer interviews, conducting interviews, and running interpretation sessions. The handbook walks you step-by-step through organizing the data so you can see your key issues, along with visioning new solutions, storyboarding to work out the details, and paper prototype interviewing to iterate the design all with as little as a two-person team with only a few weeks to spare *Includes real project examples with actual customer data that illustrate how a CD project actually works.

Videos  

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Instructional Presentations on Interview Skills  

  • Interview/Oral History Research for RSRA 298B: Master's Thesis Reading and Research (Spring 2023) Slideshow covers: Why Interviews?, Getting Context, Engaging Participants, Conducting the Interview, The Interview Guide, Note Taking, Transcription, File management, and Data Analysis.  
  • Interview Skills From an online class on February 13, 2023:  Get set up for interview research. You will leave prepared to choose among the three types of interviewing methods, equipped to develop an interview schedule, aware of data management options and their ethical implications, and knowledgeable of technologies you can use to record and transcribe your interviews. This workshop complements Intro to NVivo, a qualitative data analysis tool useful for coding interview data.

NIH Data Management & Sharing Policy (DMSP) This policy, effective January 25, 2023, applies to all research, funded or conducted in whole or in part by NIH, that results in the generation of  scientific data , including NIH-funded qualitative research. Click here to see some examples of how the DMSP policy has been applied in qualitative research studies featured in the 2021 Qualitative Data Management Plan (DMP) Competition . As a resource for the community, NIH has developed a resource for developing informed consent language in research studies where data and/or biospecimens will be stored and shared for future use. It is important to note that the DMS Policy does NOT require that informed consent obtained from research participants must allow for broad sharing and the future use of data (either with or without identifiable private information). See the FAQ for more information.

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Except where otherwise noted, this work is subject to a Creative Commons Attribution 4.0 International License , which allows anyone to share and adapt our material as long as proper attribution is given. For details and exceptions, see the Harvard Library Copyright Policy ©2021 Presidents and Fellows of Harvard College.

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Interviews in Qualitative Research

Interviews in Qualitative Research

  • Nigel King - University of Huddersfield, UK
  • Christine Horrocks - Manchester Metropolitan University, UK
  • Joanna Brooks - University of Manchester
  • Description

This dynamic user-focused book will help you to get the data you want from your interviews. It provides practical guidance regarding technique, gives top-tips from real world case studies and shares achievable checklists and interview plans.

Whether you are doing interviews in your own research or just using other researchers’ data, this book will tell you everything you need to know about designing, planning, conducting and analyzing quality interviews. It explains how to:

-          Construct ethical research designs

-          Record and manage your data

-          Transcribe your notes

-          Analyse your findings

-          Disseminate your conclusions

Written using clear, jargon-free terminology and with coverage of practical, theoretical and philosophical issues all grounded in examples from real interviews, this is the ideal guide for new and experienced researchers alike.

Nigel King  is Professor of Applied Psychology at the University of Huddersfield.

Christine Horrocks  is Professor of Applied Social Psychology and Head of the Department of Psychology at Manchester Metropolitan University. 

Joanna Brooks  is Lecturer in the Manchester Centre for Health Psychology at the University of Manchester. 

See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

For assistance with your order: Please email us at [email protected] or connect with your SAGE representative.

SAGE 2455 Teller Road Thousand Oaks, CA 91320 www.sagepub.com

As a researcher and educator I find this book to be an invaluable resource, a detailed yet accessible guide for all those engaged in qualitative research . 

Interviews in Qualitative Research (Second Edition)  should be your first line of defense as you voyage through the minefield of using the method of interviewing. As a supervisor and qualitative researcher, this is a must-have, accessible read to support researchers at any stage. A helping, comforting hand to hold for qualitative researchers!

This is an impressive and comprehensive exploration of the use of interviews in qualitative research  –  theoretically rich, practically sensible, robust in application and academically relevant. It is essential reading for researchers at all levels of their research journey – an excellent resource and contribution to the literature.

Interviews in Qualitative Research is a must read for ambitious students and developing researchers. The authors holistically detail the interview method whilst remaining clear, concise and coherent. I am confident this book will help produce high quality qualitative research!

A comprehensive and accessible introduction to qualitative interviews. It is particularly strong on the practical aspects of designing and conducting interview-based studies using a wide range of settings, methods and approaches. It will become a trusted companion to many an undergraduate or postgraduate student, especially those who value an applied perspective. The new edition therefore deserves to defend its place on many a qualitative methods reading list – including my own.

This is an accessible and authoritative text that provides a detailed outline of the interview process from start to finish [...] The book usefully adopts an applied perspective and draws on ‘real world’ case studies to exemplify the possibilities and challenges that might arise throughout the interview process. It provides much practical guidance about how interviews might be planned, conducted and analysed – with boxes, tables and figures proving a particularly useful feature

This is a very good resource for students and teaching

This is a very good reference in qualitative research. The chapters are nicely laid and it is very easy to follow both from students and teachers' perspectives. I will highly recommend this book for students, teachers and researchers.

A useful book on using qualitative interviews in research for my students who spend this year undertaking a research project.

this books outlines the benefits of conducting interviews within the area of field data. The suggestion allow students to identify areas that they are interested in and also highlights potential pitfalls that they may encounter on the way to completing a dissertation.

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For instructors, select a purchasing option, related products.

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How to carry out great interviews in qualitative research.

11 min read An interview is one of the most versatile methods used in qualitative research. Here’s what you need to know about conducting great qualitative interviews.

What is a qualitative research interview?

Qualitative research interviews are a mainstay among q ualitative research techniques, and have been in use for decades either as a primary data collection method or as an adjunct to a wider research process. A qualitative research interview is a one-to-one data collection session between a researcher and a participant. Interviews may be carried out face-to-face, over the phone or via video call using a service like Skype or Zoom.

There are three main types of qualitative research interview – structured, unstructured or semi-structured.

  • Structured interviews Structured interviews are based around a schedule of predetermined questions and talking points that the researcher has developed. At their most rigid, structured interviews may have a precise wording and question order, meaning that they can be replicated across many different interviewers and participants with relatively consistent results.
  • Unstructured interviews Unstructured interviews have no predetermined format, although that doesn’t mean they’re ad hoc or unplanned. An unstructured interview may outwardly resemble a normal conversation, but the interviewer will in fact be working carefully to make sure the right topics are addressed during the interaction while putting the participant at ease with a natural manner.
  • Semi-structured interviews Semi-structured interviews are the most common type of qualitative research interview, combining the informality and rapport of an unstructured interview with the consistency and replicability of a structured interview. The researcher will come prepared with questions and topics, but will not need to stick to precise wording. This blended approach can work well for in-depth interviews.

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What are the pros and cons of interviews in qualitative research?

As a qualitative research method interviewing is hard to beat, with applications in social research, market research, and even basic and clinical pharmacy. But like any aspect of the research process, it’s not without its limitations. Before choosing qualitative interviewing as your research method, it’s worth weighing up the pros and cons.

Pros of qualitative interviews:

  • provide in-depth information and context
  • can be used effectively when their are low numbers of participants
  • provide an opportunity to discuss and explain questions
  • useful for complex topics
  • rich in data – in the case of in-person or video interviews , the researcher can observe body language and facial expression as well as the answers to questions

Cons of qualitative interviews:

  • can be time-consuming to carry out
  • costly when compared to some other research methods
  • because of time and cost constraints, they often limit you to a small number of participants
  • difficult to standardize your data across different researchers and participants unless the interviews are very tightly structured
  • As the Open University of Hong Kong notes, qualitative interviews may take an emotional toll on interviewers

Qualitative interview guides

Semi-structured interviews are based on a qualitative interview guide, which acts as a road map for the researcher. While conducting interviews, the researcher can use the interview guide to help them stay focused on their research questions and make sure they cover all the topics they intend to.

An interview guide may include a list of questions written out in full, or it may be a set of bullet points grouped around particular topics. It can prompt the interviewer to dig deeper and ask probing questions during the interview if appropriate.

Consider writing out the project’s research question at the top of your interview guide, ahead of the interview questions. This may help you steer the interview in the right direction if it threatens to head off on a tangent.

qualitative research with interviews

Avoid bias in qualitative research interviews

According to Duke University , bias can create significant problems in your qualitative interview.

  • Acquiescence bias is common to many qualitative methods, including focus groups. It occurs when the participant feels obliged to say what they think the researcher wants to hear. This can be especially problematic when there is a perceived power imbalance between participant and interviewer. To counteract this, Duke University’s experts recommend emphasizing the participant’s expertise in the subject being discussed, and the value of their contributions.
  • Interviewer bias is when the interviewer’s own feelings about the topic come to light through hand gestures, facial expressions or turns of phrase. Duke’s recommendation is to stick to scripted phrases where this is an issue, and to make sure researchers become very familiar with the interview guide or script before conducting interviews, so that they can hone their delivery.

What kinds of questions should you ask in a qualitative interview?

The interview questions you ask need to be carefully considered both before and during the data collection process. As well as considering the topics you’ll cover, you will need to think carefully about the way you ask questions.

Open-ended interview questions – which cannot be answered with a ‘yes’ ‘no’ or ‘maybe’ – are recommended by many researchers as a way to pursue in depth information.

An example of an open-ended question is “What made you want to move to the East Coast?” This will prompt the participant to consider different factors and select at least one. Having thought about it carefully, they may give you more detailed information about their reasoning.

A closed-ended question , such as “Would you recommend your neighborhood to a friend?” can be answered without too much deliberation, and without giving much information about personal thoughts, opinions and feelings.

Follow-up questions can be used to delve deeper into the research topic and to get more detail from open-ended questions. Examples of follow-up questions include:

  • What makes you say that?
  • What do you mean by that?
  • Can you tell me more about X?
  • What did/does that mean to you?

As well as avoiding closed-ended questions, be wary of leading questions. As with other qualitative research techniques such as surveys or focus groups, these can introduce bias in your data. Leading questions presume a certain point of view shared by the interviewer and participant, and may even suggest a foregone conclusion.

An example of a leading question might be: “You moved to New York in 1990, didn’t you?” In answering the question, the participant is much more likely to agree than disagree. This may be down to acquiescence bias or a belief that the interviewer has checked the information and already knows the correct answer.

Other leading questions involve adjectival phrases or other wording that introduces negative or positive connotations about a particular topic. An example of this kind of leading question is: “Many employees dislike wearing masks to work. How do you feel about this?” It presumes a positive opinion and the participant may be swayed by it, or not want to contradict the interviewer.

Harvard University’s guidelines for qualitative interview research add that you shouldn’t be afraid to ask embarrassing questions – “if you don’t ask, they won’t tell.” Bear in mind though that too much probing around sensitive topics may cause the interview participant to withdraw. The Harvard guidelines recommend leaving sensitive questions til the later stages of the interview when a rapport has been established.

More tips for conducting qualitative interviews

Observing a participant’s body language can give you important data about their thoughts and feelings. It can also help you decide when to broach a topic, and whether to use a follow-up question or return to the subject later in the interview.

Be conscious that the participant may regard you as the expert, not themselves. In order to make sure they express their opinions openly, use active listening skills like verbal encouragement and paraphrasing and clarifying their meaning to show how much you value what they are saying.

Remember that part of the goal is to leave the interview participant feeling good about volunteering their time and their thought process to your research. Aim to make them feel empowered , respected and heard.

Unstructured interviews can demand a lot of a researcher, both cognitively and emotionally. Be sure to leave time in between in-depth interviews when scheduling your data collection to make sure you maintain the quality of your data, as well as your own well-being .

Recording and transcribing interviews

Historically, recording qualitative research interviews and then transcribing the conversation manually would have represented a significant part of the cost and time involved in research projects that collect qualitative data.

Fortunately, researchers now have access to digital recording tools, and even speech-to-text technology that can automatically transcribe interview data using AI and machine learning. This type of tool can also be used to capture qualitative data from qualitative research (focus groups,ect.) making this kind of social research or market research much less time consuming.

qualitative research with interviews

Data analysis

Qualitative interview data is unstructured, rich in content and difficult to analyze without the appropriate tools. Fortunately, machine learning and AI can once again make things faster and easier when you use qualitative methods like the research interview.

Text analysis tools and natural language processing software can ‘read’ your transcripts and voice data and identify patterns and trends across large volumes of text or speech. They can also perform khttps://www.qualtrics.com/experience-management/research/sentiment-analysis/

which assesses overall trends in opinion and provides an unbiased overall summary of how participants are feeling.

qualitative research with interviews

Another feature of text analysis tools is their ability to categorize information by topic, sorting it into groupings that help you organize your data according to the topic discussed.

All in all, interviews are a valuable technique for qualitative research in business, yielding rich and detailed unstructured data. Historically, they have only been limited by the human capacity to interpret and communicate results and conclusions, which demands considerable time and skill.

When you combine this data with AI tools that can interpret it quickly and automatically, it becomes easy to analyze and structure, dovetailing perfectly with your other business data. An additional benefit of natural language analysis tools is that they are free of subjective biases, and can replicate the same approach across as much data as you choose. By combining human research skills with machine analysis, qualitative research methods such as interviews are more valuable than ever to your business.

Related resources

Market intelligence 10 min read, marketing insights 11 min read, ethnographic research 11 min read, qualitative vs quantitative research 13 min read, qualitative research questions 11 min read, qualitative research design 12 min read, primary vs secondary research 14 min read, request demo.

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  • Knowledge Base

Methodology

  • What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

Published on June 19, 2020 by Pritha Bhandari . Revised on June 22, 2023.

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

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

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

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

Table of contents

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

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

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

Note that qualitative research is at risk for certain research biases including the Hawthorne effect , observer bias , recall bias , and social desirability bias . While not always totally avoidable, awareness of potential biases as you collect and analyze your data can prevent them from impacting your work too much.

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

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

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

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

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

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

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

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

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

  • Flexibility

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

  • Natural settings

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

  • Meaningful insights

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

  • Generation of new ideas

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

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

  • Unreliability

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

  • Subjectivity

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

  • Limited generalizability

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

  • Labor-intensive

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

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

  • Chi square goodness of fit test
  • Degrees of freedom
  • Null hypothesis
  • Discourse analysis
  • Control groups
  • Mixed methods research
  • Non-probability sampling
  • Quantitative research
  • Inclusion and exclusion criteria

Research bias

  • Rosenthal effect
  • Implicit bias
  • Cognitive bias
  • Selection bias
  • Negativity bias
  • Status quo bias

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

Quantitative methods allow you to systematically measure variables and test hypotheses . Qualitative methods allow you to explore concepts and experiences in more detail.

There are five common approaches to qualitative research :

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

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

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

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

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

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Introduction to Research Methods

6 qualitative research and interviews.

So we’ve described doing a survey and collecting quantitative data. But not all questions can best be answered by a survey. A survey is great for understanding what people think (for example), but not why they think what they do. If your research is intending to understand the underlying motivations or reasons behind peoples actions, or to build a deeper understanding on the background of a subject, an interview may be the more appropriate data collection method.

Interviews are a method of data collection that consist of two or more people exchanging information through a structured process of questions and answers. Questions are designed by the researcher to thoughtfully collect in-depth information on a topic or set of topics as related to the central research question. Interviews typically occur in-person, although good interviews can also be conducted remotely via the phone or video conferencing. Unlike surveys, interviews give the opportunity to ask follow-up questions and thoughtfully engage with participants on the spot (rather than the anonymous and impartial format of survey research).

And surveys can be used in qualitative or quantitative research – though they’re more typically a qualitative technique. In-depth interviews , containing open-ended questions and structured by an interview guide . One can also do a standardized interview with closed-ended questions (i.e. answer options) that are structured by an interview schedule as part of quantitative research. While these are called interviews they’re far closer to surveys, so we wont cover them again in this chapter. The terms used for in-depth interviews we’ll cover in the next section.

6.1 Interviews

In-depth interviews allow participants to describe experiences in their own words (a primary strength of the interview format). Strong in-depth interviews will include many open-ended questions that allow participants to respond in their own words, share new ideas, and lead the conversation in different directions. The purpose of open-ended questions and in-depth interviews is to hear as much as possible in the person’s own voice, to collect new information and ideas, and to achieve a level of depth not possible in surveys or most other forms of data collection.

Typically, an interview guide is used to create a soft structure for the conversation and is an important preparation tool for the researcher. You can not go into an interview unprepared and just “wing it”; what the interview guide allows you to do is map out a framework, order of topics, and may include specific questions to use during the interview. Generally, the interview guide is thought of as just that — a guide to use in order to keep the interview focused. It is not set in stone and a skilled researcher can change the order of questions or topics in an interviews based on the organic conversation flow.

Depending on the experience and skill level of the researcher, an interview guide can be as simple as a list of topics to cover. However, for consistency and quality of research, the interviewer may want to take the time to at least practice writing out questions in advance to ensure that phrasing and word choices are as clear, objective, and focused as possible. It’s worth remembering that working out the wording of questions in advance allows researchers to ensure more consistency across interview. The interview guide below, taken from the wonderful and free textbook Principles of Sociological Inquiry , shows an interview guide that just has topics.

qualitative research with interviews

Alternatively, you can use a more detailed guide that lists out possible questions, as shown below. A more detailed guide is probably better for an interviewer that has less experience, or is just beginning to work on a given topic.

qualitative research with interviews

The purpose of an interview guide is to help ask effective questions and to support the process of acquiring the best possible data for your research. Topics and questions should be organized thematically, and in a natural progression that will allow the conversation to flow and deepen throughout the course of the interview. Often, researchers will attempt to memorize or partially memorize the interview guide, in order to be more fully present with the participant during the conversation.

6.2 Asking good Questions

Remember, the purposes of interviews is to go more in-depth with an individual than is possible with a generalized survey. For this reason, it is important to use the guide as a starting point but not to be overly tethered to it during the actual interview process. You may get stuck when respondents give you shorter answers than you expect, or don’t provide the type of depth that you need for your research. Often, you may want to probe for more specifics. Think about using follow up questions like “How does/did that affect you?” or “How does X make you feel?” and “Tell me about a time where X…”

For example, if I was researching the relationship between pets and mental health, some strong open-ended questions might be: * How does your pet typically make you feel when you wake up in the morning? * How does your pet generally affect your mood when you arrive home in the evening? * Tell me about a time when your pet had a significant impact on your emotional state.

Questions framed in this manner leave plenty of room for the respondent to answer in their own words, as opposed to leading and/or truncated questions, such as: * Does being with your pet make you happy? * After a bad day, how much does seeing your pet improve your mood? * Tell me about how important your pet is to your mental health.

These questions assume outcomes and will not result in high quality research. Researchers should always avoid asking leading questions that give away an expected answer or suggest particular responses. For instance, if I ask “we need to spend more on public schools, don’t you think?” the respondent is more likely to agree regardless of their own thoughts. Some wont, but humans generally have a strong natural desire to be agreeable. That’s why leaving your questions neutral and open so that respondents can speak to their experiences and views is critical.

6.3 Analyzing Interview Data

Writing good questions and interviewing respondents are just the first steps of the interview process. After these stages, the researcher still has a lot of work to do to collect usable data from the interview. The researcher must spend time coding and analyzing the interview to retrieve this data. Just doing an interview wont produce data. Think about how many conversations you have everyday, and none of those are leaving you swimming in data.

Hopefully you can record your interviews. Recording your interviews will allow you the opportunity to transcribe them word for word later. If you can’t record the interview you’ll need to take detailed notes so that you can reconstruct what you heard later. Do not trust yourself to “just remember” the conversation. You’re collecting data, precious data that you’re spending time and energy to collect. Treat it as important and valuable. Remember our description of the methodology section from Chapter 2, you need to maintain a chain of custody on your data. If you just remembered the interview, you could be accused of making up the results. Your interview notes and the recording become part of that chain of custody to prove to others that your interviews were real and that your results are accurate.

Assuming you recorded your interview, the first step in the analysis process is transcribing the interview. A transcription is a written record of every word in an interview. Transcriptions can either be completed by the researcher or by a hired worker, though it is good practice for the researcher to transcribe the interview him or herself. Researchers should keep the following points in mind regarding transcriptions: * The interview should take place in a quiet location with minimal background noise to produce a clear recording; * Transcribing interviews is a time-consuming process and may take two to three times longer than the actual interview; * Transcriptions provide a more precise record of the interview than hand written notes and allow the interviewer to focus during the interview.

After transcribing the interview, the next step is to analyze the responses. Coding is the main form of analysis used for interviews and involves studying a transcription to identify important themes. These themes are categorized into codes, which are words or phrases that denote an idea.

You’ll typically being with several codes in mind that are generated by key ideas you week seeking in the questions, but you can also being by using open coding to understand the results. An open coding process involves reading through the transcript multiple times and paying close attention to each line of the text to discover noteworthy concepts. During the open coding process, the researcher keeps an open mind to find any codes that may be relevant to the research topic.

After the open coding process is complete, focused coding can begin. Focused coding takes a closer look at the notes compiled during the open coding stage to merge common codes and define what the codes mean in the context of the research project.

Imagine a researcher is conducting interviews to learn about various people’s experiences of childhood in New Orleans. The following example shows several codes that this researcher extrapolated from an interview with one of their subjects.

qualitative research with interviews

6.4 Using interview data

The next chapter will address ways to identify people to interview, but most of the remainder of the book will address how to analyze quantitative data. That shouldn’t be taken as a sign that quantitative data is better, or that it’s easier to use interview data. Because in an interview the researcher must interpret the words of others it is often more challenging to identify your findings and clearly answer your research question. However, quantitative data is more common, and there are more different things you can do with it, so we spend a lot of the textbook focusing on it.

I’ll work through one more example of using interview data though. It takes a lot of practice to be a good and skilled interviewer. What I show below is a brief excerpt of an interview I did, and how that data was used in a resulting paper I wrote. These aren’t the only way you can use interview data, but it’s an example of what the intermediary and final product might look like.

The overall project these are drawn from was concerned with minor league baseball stadiums, but the specific part I’m pulling from here was studying the decline and rejuvenation of downtown around those stadiums in several cities. You’ll see that I’m using the words of the respondent fairly directly, because that’s my data. But I’m not just relying on one respondent and trusting them, I did a few dozen interviews in order to understand the commonalities in people’s perspectives to build a narrative around my research question.

Excerpt from Notes

Excerpt from Notes

Excerpt from Resulting Paper

Excerpt from Resulting Paper

How many interviews are necessary? It actually doesn’t take many. What you want to observe in your interviews is theoretical saturation , where the codes you use in the transcript begin to appear across conversations and groups. If different people disagree that’s fine, but what you want to understand is the commonalities across peoples perspectives. Most research on the subject says that with 8 interviews you’ll typically start to see a decline in new information gathered. That doesn’t mean you won’t get new words , but you’ll stop hearing completely unique perspectives or gain novel insights. At that point, where you’ve ‘heard it all before’ you can stop, because you’ve probably identified the answer to the questions you were trying to research.

6.5 Ensuring Anonymity

One significant ethical concern with interviews, that also applies to surveys, is making sure that respondents maintain anonymity. In either form of data collection you may be asking respondents deeply personal questions, that if exposed may cause legal, personal, or professional harm. Notice that in the excerpt of the paper above the respondents are only identified by an id I assigned (Louisville D) and their career, rather than their name. I can only include the excerpt of the interview notes above because there are no details that might lead to them being identified.

You may want to report details about a person to contextualize the data you gathered, but you should always ensure that no one can be identified from your research. For instance, if you were doing research on racism at large companies, you may want to preface people’s comments by their race, as there is a good chance that white and minority employees would feel differently about the issues. However, if you preface someones comments by saying they’re a minority manager, that may violate their anonymity. Even if you don’t state what company you did interviews with, that may be enough detail for their co-workers to identify them if there are few minority managers at the company. As such, always think long and hard about whether there is any way that the participation of respondents may be exposed.

6.6 Why not both?

qualitative research with interviews

We’ve discussed surveys and interviews as different methods the last two chapters, but they can also complement each other.

For instance, let’s say you’re curious to study people who change opinions on abortion, either going from support to opposition or vice versa. You could use a survey to understand the prevalence of changing opinions, i.e. what percentage of people in your city have changed their views. That would help to establish whether this is a prominent issue, or whether it’s a rare phenomenon. But it would be difficult to understand from the survey what makes people change their views. You could add an open ended question for anyone that said they changed their opinion, but many people won’t respond and few will provide the level of detail necessary to understand their motivations. Interviews with people that have changed their opinions would give you an opportunity to explore how their experiences and beliefs have changed in combination with their views towards abortion.

6.7 Summary

In the last two chapters we’ve discussed the two most prominent methods of data collection in the social sciences: surveys and interviews. What we haven’t discussed though is how to identify the people you’ll collect data from; that’s called a sampling strategy. In the next chapter

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  • Published: 05 October 2018

Interviews and focus groups in qualitative research: an update for the digital age

  • P. Gill 1 &
  • J. Baillie 2  

British Dental Journal volume  225 ,  pages 668–672 ( 2018 ) Cite this article

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Highlights that qualitative research is used increasingly in dentistry. Interviews and focus groups remain the most common qualitative methods of data collection.

Suggests the advent of digital technologies has transformed how qualitative research can now be undertaken.

Suggests interviews and focus groups can offer significant, meaningful insight into participants' experiences, beliefs and perspectives, which can help to inform developments in dental practice.

Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

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Introduction

Traditionally, research in dentistry has primarily been quantitative in nature. 1 However, in recent years, there has been a growing interest in qualitative research within the profession, due to its potential to further inform developments in practice, policy, education and training. Consequently, in 2008, the British Dental Journal (BDJ) published a four paper qualitative research series, 2 , 3 , 4 , 5 to help increase awareness and understanding of this particular methodological approach.

Since the papers were originally published, two scoping reviews have demonstrated the ongoing proliferation in the use of qualitative research within the field of oral healthcare. 1 , 6 To date, the original four paper series continue to be well cited and two of the main papers remain widely accessed among the BDJ readership. 2 , 3 The potential value of well-conducted qualitative research to evidence-based practice is now also widely recognised by service providers, policy makers, funding bodies and those who commission, support and use healthcare research.

Besides increasing standalone use, qualitative methods are now also routinely incorporated into larger mixed method study designs, such as clinical trials, as they can offer additional, meaningful insights into complex problems that simply could not be provided by quantitative methods alone. Qualitative methods can also be used to further facilitate in-depth understanding of important aspects of clinical trial processes, such as recruitment. For example, Ellis et al . investigated why edentulous older patients, dissatisfied with conventional dentures, decline implant treatment, despite its established efficacy, and frequently refuse to participate in related randomised clinical trials, even when financial constraints are removed. 7 Through the use of focus groups in Canada and the UK, the authors found that fears of pain and potential complications, along with perceived embarrassment, exacerbated by age, are common reasons why older patients typically refuse dental implants. 7

The last decade has also seen further developments in qualitative research, due to the ongoing evolution of digital technologies. These developments have transformed how researchers can access and share information, communicate and collaborate, recruit and engage participants, collect and analyse data and disseminate and translate research findings. 8 Where appropriate, such technologies are therefore capable of extending and enhancing how qualitative research is undertaken. 9 For example, it is now possible to collect qualitative data via instant messaging, email or online/video chat, using appropriate online platforms.

These innovative approaches to research are therefore cost-effective, convenient, reduce geographical constraints and are often useful for accessing 'hard to reach' participants (for example, those who are immobile or socially isolated). 8 , 9 However, digital technologies are still relatively new and constantly evolving and therefore present a variety of pragmatic and methodological challenges. Furthermore, given their very nature, their use in many qualitative studies and/or with certain participant groups may be inappropriate and should therefore always be carefully considered. While it is beyond the scope of this paper to provide a detailed explication regarding the use of digital technologies in qualitative research, insight is provided into how such technologies can be used to facilitate the data collection process in interviews and focus groups.

In light of such developments, it is perhaps therefore timely to update the main paper 3 of the original BDJ series. As with the previous publications, this paper has been purposely written in an accessible style, to enhance readability, particularly for those who are new to qualitative research. While the focus remains on the most common qualitative methods of data collection – interviews and focus groups – appropriate revisions have been made to provide a novel perspective, and should therefore be helpful to those who would like to know more about qualitative research. This paper specifically focuses on undertaking qualitative research with adult participants only.

Overview of qualitative research

Qualitative research is an approach that focuses on people and their experiences, behaviours and opinions. 10 , 11 The qualitative researcher seeks to answer questions of 'how' and 'why', providing detailed insight and understanding, 11 which quantitative methods cannot reach. 12 Within qualitative research, there are distinct methodologies influencing how the researcher approaches the research question, data collection and data analysis. 13 For example, phenomenological studies focus on the lived experience of individuals, explored through their description of the phenomenon. Ethnographic studies explore the culture of a group and typically involve the use of multiple methods to uncover the issues. 14

While methodology is the 'thinking tool', the methods are the 'doing tools'; 13 the ways in which data are collected and analysed. There are multiple qualitative data collection methods, including interviews, focus groups, observations, documentary analysis, participant diaries, photography and videography. Two of the most commonly used qualitative methods are interviews and focus groups, which are explored in this article. The data generated through these methods can be analysed in one of many ways, according to the methodological approach chosen. A common approach is thematic data analysis, involving the identification of themes and subthemes across the data set. Further information on approaches to qualitative data analysis has been discussed elsewhere. 1

Qualitative research is an evolving and adaptable approach, used by different disciplines for different purposes. Traditionally, qualitative data, specifically interviews, focus groups and observations, have been collected face-to-face with participants. In more recent years, digital technologies have contributed to the ongoing evolution of qualitative research. Digital technologies offer researchers different ways of recruiting participants and collecting data, and offer participants opportunities to be involved in research that is not necessarily face-to-face.

Research interviews are a fundamental qualitative research method 15 and are utilised across methodological approaches. Interviews enable the researcher to learn in depth about the perspectives, experiences, beliefs and motivations of the participant. 3 , 16 Examples include, exploring patients' perspectives of fear/anxiety triggers in dental treatment, 17 patients' experiences of oral health and diabetes, 18 and dental students' motivations for their choice of career. 19

Interviews may be structured, semi-structured or unstructured, 3 according to the purpose of the study, with less structured interviews facilitating a more in depth and flexible interviewing approach. 20 Structured interviews are similar to verbal questionnaires and are used if the researcher requires clarification on a topic; however they produce less in-depth data about a participant's experience. 3 Unstructured interviews may be used when little is known about a topic and involves the researcher asking an opening question; 3 the participant then leads the discussion. 20 Semi-structured interviews are commonly used in healthcare research, enabling the researcher to ask predetermined questions, 20 while ensuring the participant discusses issues they feel are important.

Interviews can be undertaken face-to-face or using digital methods when the researcher and participant are in different locations. Audio-recording the interview, with the consent of the participant, is essential for all interviews regardless of the medium as it enables accurate transcription; the process of turning the audio file into a word-for-word transcript. This transcript is the data, which the researcher then analyses according to the chosen approach.

Types of interview

Qualitative studies often utilise one-to-one, face-to-face interviews with research participants. This involves arranging a mutually convenient time and place to meet the participant, signing a consent form and audio-recording the interview. However, digital technologies have expanded the potential for interviews in research, enabling individuals to participate in qualitative research regardless of location.

Telephone interviews can be a useful alternative to face-to-face interviews and are commonly used in qualitative research. They enable participants from different geographical areas to participate and may be less onerous for participants than meeting a researcher in person. 15 A qualitative study explored patients' perspectives of dental implants and utilised telephone interviews due to the quality of the data that could be yielded. 21 The researcher needs to consider how they will audio record the interview, which can be facilitated by purchasing a recorder that connects directly to the telephone. One potential disadvantage of telephone interviews is the inability of the interviewer and researcher to see each other. This is resolved using software for audio and video calls online – such as Skype – to conduct interviews with participants in qualitative studies. Advantages of this approach include being able to see the participant if video calls are used, enabling observation of non-verbal communication, and the software can be free to use. However, participants are required to have a device and internet connection, as well as being computer literate, potentially limiting who can participate in the study. One qualitative study explored the role of dental hygienists in reducing oral health disparities in Canada. 22 The researcher conducted interviews using Skype, which enabled dental hygienists from across Canada to be interviewed within the research budget, accommodating the participants' schedules. 22

A less commonly used approach to qualitative interviews is the use of social virtual worlds. A qualitative study accessed a social virtual world – Second Life – to explore the health literacy skills of individuals who use social virtual worlds to access health information. 23 The researcher created an avatar and interview room, and undertook interviews with participants using voice and text methods. 23 This approach to recruitment and data collection enables individuals from diverse geographical locations to participate, while remaining anonymous if they wish. Furthermore, for interviews conducted using text methods, transcription of the interview is not required as the researcher can save the written conversation with the participant, with the participant's consent. However, the researcher and participant need to be familiar with how the social virtual world works to engage in an interview this way.

Conducting an interview

Ensuring informed consent before any interview is a fundamental aspect of the research process. Participants in research must be afforded autonomy and respect; consent should be informed and voluntary. 24 Individuals should have the opportunity to read an information sheet about the study, ask questions, understand how their data will be stored and used, and know that they are free to withdraw at any point without reprisal. The qualitative researcher should take written consent before undertaking the interview. In a face-to-face interview, this is straightforward: the researcher and participant both sign copies of the consent form, keeping one each. However, this approach is less straightforward when the researcher and participant do not meet in person. A recent protocol paper outlined an approach for taking consent for telephone interviews, which involved: audio recording the participant agreeing to each point on the consent form; the researcher signing the consent form and keeping a copy; and posting a copy to the participant. 25 This process could be replicated in other interview studies using digital methods.

There are advantages and disadvantages of using face-to-face and digital methods for research interviews. Ultimately, for both approaches, the quality of the interview is determined by the researcher. 16 Appropriate training and preparation are thus required. Healthcare professionals can use their interpersonal communication skills when undertaking a research interview, particularly questioning, listening and conversing. 3 However, the purpose of an interview is to gain information about the study topic, 26 rather than offering help and advice. 3 The researcher therefore needs to listen attentively to participants, enabling them to describe their experience without interruption. 3 The use of active listening skills also help to facilitate the interview. 14 Spradley outlined elements and strategies for research interviews, 27 which are a useful guide for qualitative researchers:

Greeting and explaining the project/interview

Asking descriptive (broad), structural (explore response to descriptive) and contrast (difference between) questions

Asymmetry between the researcher and participant talking

Expressing interest and cultural ignorance

Repeating, restating and incorporating the participant's words when asking questions

Creating hypothetical situations

Asking friendly questions

Knowing when to leave.

For semi-structured interviews, a topic guide (also called an interview schedule) is used to guide the content of the interview – an example of a topic guide is outlined in Box 1 . The topic guide, usually based on the research questions, existing literature and, for healthcare professionals, their clinical experience, is developed by the research team. The topic guide should include open ended questions that elicit in-depth information, and offer participants the opportunity to talk about issues important to them. This is vital in qualitative research where the researcher is interested in exploring the experiences and perspectives of participants. It can be useful for qualitative researchers to pilot the topic guide with the first participants, 10 to ensure the questions are relevant and understandable, and amending the questions if required.

Regardless of the medium of interview, the researcher must consider the setting of the interview. For face-to-face interviews, this could be in the participant's home, in an office or another mutually convenient location. A quiet location is preferable to promote confidentiality, enable the researcher and participant to concentrate on the conversation, and to facilitate accurate audio-recording of the interview. For interviews using digital methods the same principles apply: a quiet, private space where the researcher and participant feel comfortable and confident to participate in an interview.

Box 1: Example of a topic guide

Study focus: Parents' experiences of brushing their child's (aged 0–5) teeth

1. Can you tell me about your experience of cleaning your child's teeth?

How old was your child when you started cleaning their teeth?

Why did you start cleaning their teeth at that point?

How often do you brush their teeth?

What do you use to brush their teeth and why?

2. Could you explain how you find cleaning your child's teeth?

Do you find anything difficult?

What makes cleaning their teeth easier for you?

3. How has your experience of cleaning your child's teeth changed over time?

Has it become easier or harder?

Have you changed how often and how you clean their teeth? If so, why?

4. Could you describe how your child finds having their teeth cleaned?

What do they enjoy about having their teeth cleaned?

Is there anything they find upsetting about having their teeth cleaned?

5. Where do you look for information/advice about cleaning your child's teeth?

What did your health visitor tell you about cleaning your child's teeth? (If anything)

What has the dentist told you about caring for your child's teeth? (If visited)

Have any family members given you advice about how to clean your child's teeth? If so, what did they tell you? Did you follow their advice?

6. Is there anything else you would like to discuss about this?

Focus groups

A focus group is a moderated group discussion on a pre-defined topic, for research purposes. 28 , 29 While not aligned to a particular qualitative methodology (for example, grounded theory or phenomenology) as such, focus groups are used increasingly in healthcare research, as they are useful for exploring collective perspectives, attitudes, behaviours and experiences. Consequently, they can yield rich, in-depth data and illuminate agreement and inconsistencies 28 within and, where appropriate, between groups. Examples include public perceptions of dental implants and subsequent impact on help-seeking and decision making, 30 and general dental practitioners' views on patient safety in dentistry. 31

Focus groups can be used alone or in conjunction with other methods, such as interviews or observations, and can therefore help to confirm, extend or enrich understanding and provide alternative insights. 28 The social interaction between participants often results in lively discussion and can therefore facilitate the collection of rich, meaningful data. However, they are complex to organise and manage, due to the number of participants, and may also be inappropriate for exploring particularly sensitive issues that many participants may feel uncomfortable about discussing in a group environment.

Focus groups are primarily undertaken face-to-face but can now also be undertaken online, using appropriate technologies such as email, bulletin boards, online research communities, chat rooms, discussion forums, social media and video conferencing. 32 Using such technologies, data collection can also be synchronous (for example, online discussions in 'real time') or, unlike traditional face-to-face focus groups, asynchronous (for example, online/email discussions in 'non-real time'). While many of the fundamental principles of focus group research are the same, regardless of how they are conducted, a number of subtle nuances are associated with the online medium. 32 Some of which are discussed further in the following sections.

Focus group considerations

Some key considerations associated with face-to-face focus groups are: how many participants are required; should participants within each group know each other (or not) and how many focus groups are needed within a single study? These issues are much debated and there is no definitive answer. However, the number of focus groups required will largely depend on the topic area, the depth and breadth of data needed, the desired level of participation required 29 and the necessity (or not) for data saturation.

The optimum group size is around six to eight participants (excluding researchers) but can work effectively with between three and 14 participants. 3 If the group is too small, it may limit discussion, but if it is too large, it may become disorganised and difficult to manage. It is, however, prudent to over-recruit for a focus group by approximately two to three participants, to allow for potential non-attenders. For many researchers, particularly novice researchers, group size may also be informed by pragmatic considerations, such as the type of study, resources available and moderator experience. 28 Similar size and mix considerations exist for online focus groups. Typically, synchronous online focus groups will have around three to eight participants but, as the discussion does not happen simultaneously, asynchronous groups may have as many as 10–30 participants. 33

The topic area and potential group interaction should guide group composition considerations. Pre-existing groups, where participants know each other (for example, work colleagues) may be easier to recruit, have shared experiences and may enjoy a familiarity, which facilitates discussion and/or the ability to challenge each other courteously. 3 However, if there is a potential power imbalance within the group or if existing group norms and hierarchies may adversely affect the ability of participants to speak freely, then 'stranger groups' (that is, where participants do not already know each other) may be more appropriate. 34 , 35

Focus group management

Face-to-face focus groups should normally be conducted by two researchers; a moderator and an observer. 28 The moderator facilitates group discussion, while the observer typically monitors group dynamics, behaviours, non-verbal cues, seating arrangements and speaking order, which is essential for transcription and analysis. The same principles of informed consent, as discussed in the interview section, also apply to focus groups, regardless of medium. However, the consent process for online discussions will probably be managed somewhat differently. For example, while an appropriate participant information leaflet (and consent form) would still be required, the process is likely to be managed electronically (for example, via email) and would need to specifically address issues relating to technology (for example, anonymity and use, storage and access to online data). 32

The venue in which a face to face focus group is conducted should be of a suitable size, private, quiet, free from distractions and in a collectively convenient location. It should also be conducted at a time appropriate for participants, 28 as this is likely to promote attendance. As with interviews, the same ethical considerations apply (as discussed earlier). However, online focus groups may present additional ethical challenges associated with issues such as informed consent, appropriate access and secure data storage. Further guidance can be found elsewhere. 8 , 32

Before the focus group commences, the researchers should establish rapport with participants, as this will help to put them at ease and result in a more meaningful discussion. Consequently, researchers should introduce themselves, provide further clarity about the study and how the process will work in practice and outline the 'ground rules'. Ground rules are designed to assist, not hinder, group discussion and typically include: 3 , 28 , 29

Discussions within the group are confidential to the group

Only one person can speak at a time

All participants should have sufficient opportunity to contribute

There should be no unnecessary interruptions while someone is speaking

Everyone can be expected to be listened to and their views respected

Challenging contrary opinions is appropriate, but ridiculing is not.

Moderating a focus group requires considered management and good interpersonal skills to help guide the discussion and, where appropriate, keep it sufficiently focused. Avoid, therefore, participating, leading, expressing personal opinions or correcting participants' knowledge 3 , 28 as this may bias the process. A relaxed, interested demeanour will also help participants to feel comfortable and promote candid discourse. Moderators should also prevent the discussion being dominated by any one person, ensure differences of opinions are discussed fairly and, if required, encourage reticent participants to contribute. 3 Asking open questions, reflecting on significant issues, inviting further debate, probing responses accordingly, and seeking further clarification, as and where appropriate, will help to obtain sufficient depth and insight into the topic area.

Moderating online focus groups requires comparable skills, particularly if the discussion is synchronous, as the discussion may be dominated by those who can type proficiently. 36 It is therefore important that sufficient time and respect is accorded to those who may not be able to type as quickly. Asynchronous discussions are usually less problematic in this respect, as interactions are less instant. However, moderating an asynchronous discussion presents additional challenges, particularly if participants are geographically dispersed, as they may be online at different times. Consequently, the moderator will not always be present and the discussion may therefore need to occur over several days, which can be difficult to manage and facilitate and invariably requires considerable flexibility. 32 It is also worth recognising that establishing rapport with participants via online medium is often more challenging than via face-to-face and may therefore require additional time, skills, effort and consideration.

As with research interviews, focus groups should be guided by an appropriate interview schedule, as discussed earlier in the paper. For example, the schedule will usually be informed by the review of the literature and study aims, and will merely provide a topic guide to help inform subsequent discussions. To provide a verbatim account of the discussion, focus groups must be recorded, using an audio-recorder with a good quality multi-directional microphone. While videotaping is possible, some participants may find it obtrusive, 3 which may adversely affect group dynamics. The use (or not) of a video recorder, should therefore be carefully considered.

At the end of the focus group, a few minutes should be spent rounding up and reflecting on the discussion. 28 Depending on the topic area, it is possible that some participants may have revealed deeply personal issues and may therefore require further help and support, such as a constructive debrief or possibly even referral on to a relevant third party. It is also possible that some participants may feel that the discussion did not adequately reflect their views and, consequently, may no longer wish to be associated with the study. 28 Such occurrences are likely to be uncommon, but should they arise, it is important to further discuss any concerns and, if appropriate, offer them the opportunity to withdraw (including any data relating to them) from the study. Immediately after the discussion, researchers should compile notes regarding thoughts and ideas about the focus group, which can assist with data analysis and, if appropriate, any further data collection.

Qualitative research is increasingly being utilised within dental research to explore the experiences, perspectives, motivations and beliefs of participants. The contributions of qualitative research to evidence-based practice are increasingly being recognised, both as standalone research and as part of larger mixed-method studies, including clinical trials. Interviews and focus groups remain commonly used data collection methods in qualitative research, and with the advent of digital technologies, their utilisation continues to evolve. However, digital methods of qualitative data collection present additional methodological, ethical and practical considerations, but also potentially offer considerable flexibility to participants and researchers. Consequently, regardless of format, qualitative methods have significant potential to inform important areas of dental practice, policy and further related research.

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Gill, P., Baillie, J. Interviews and focus groups in qualitative research: an update for the digital age. Br Dent J 225 , 668–672 (2018). https://doi.org/10.1038/sj.bdj.2018.815

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Issue Date : 12 October 2018

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qualitative research with interviews

Research-Methodology

Interviews can be defined as a qualitative research technique which involves “conducting intensive individual interviews with a small number of respondents to explore their perspectives on a particular idea, program or situation.” [1]

There are three different formats of interviews: structured, semi-structured and unstructured.

Structured interviews consist of a series of pre-determined questions that all interviewees answer in the same order. Data analysis usually tends to be more straightforward because researcher can compare and contrast different answers given to the same questions.

Unstructured interviews are usually the least reliable from research viewpoint, because no questions are prepared prior to the interview and data collection is conducted in an informal manner. Unstructured interviews can be associated with a high level of bias and comparison of answers given by different respondents tends to be difficult due to the differences in formulation of questions.

Semi-structured interviews contain the components of both, structured and unstructured interviews. In semi-structured interviews, interviewer prepares a set of same questions to be answered by all interviewees. At the same time, additional questions might be asked during interviews to clarify and/or further expand certain issues.

Advantages of interviews include possibilities of collecting detailed information about research questions.  Moreover, in in this type of primary data collection researcher has direct control over the flow of process and she has a chance to clarify certain issues during the process if needed. Disadvantages, on the other hand, include longer time requirements and difficulties associated with arranging an appropriate time with perspective sample group members to conduct interviews.

When conducting interviews you should have an open mind and refrain from displaying disagreements in any forms when viewpoints expressed by interviewees contradict your own ideas. Moreover, timing and environment for interviews need to be scheduled effectively. Specifically, interviews need to be conducted in a relaxed environment, free of any forms of pressure for interviewees whatsoever.

Respected scholars warn that “in conducting an interview the interviewer should attempt to create a friendly, non-threatening atmosphere. Much as one does with a cover letter, the interviewer should give a brief, casual introduction to the study; stress the importance of the person’s participation; and assure anonymity, or at least confidentiality, when possible.” [2]

There is a risk of interviewee bias during the primary data collection process and this would seriously compromise the validity of the project findings. Some interviewer bias can be avoided by ensuring that the interviewer does not overreact to responses of the interviewee. Other steps that can be taken to help avoid or reduce interviewer bias include having the interviewer dress inconspicuously and appropriately for the environment and holding the interview in a private setting.  [3]

My e-book, The Ultimate Guide to Writing a Dissertation in Business Studies: a step by step assistance offers practical assistance to complete a dissertation with minimum or no stress. The e-book covers all stages of writing a dissertation starting from the selection to the research area to submitting the completed version of the work within the deadline.John Dudovskiy

Interviews

[1] Boyce, C. & Neale, P. (2006) “Conducting in-depth Interviews: A Guide for Designing and Conducting In-Depth Interviews”, Pathfinder International Tool Series

[2] Connaway, L.S.& Powell, R.P.(2010) “Basic Research Methods for Librarians” ABC-CLIO

[3] Connaway, L.S.& Powell, R.P.(2010) “Basic Research Methods for Librarians” ABC-CLIO

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Qualitative Interview: What it is & How to conduct one

qualitative interview

A qualitative interview is commonly used in research projects involving new products, brand positioning, purchase dynamics, market research, social research, behavioral analysis, exploring market segments, etc. Recent data also suggests that it is highly effective when used in employee engagement initiatives.

It has also proven to be extremely helpful when it comes to problem definition as well as developing an approach to a particular problem.

What is a Qualitative Interview?

A qualitative Interview is a research approach used in a qualitative study where more personal interaction is required and detailed in depth information is gathered from the participant. Qualitative interviews usually involve follow-up questions and are conducted in a conversation or discussion format.

A qualitative interview is a more personal form of research agenda compared to general questionnaires or focused group studies. Such formats often include open-ended and follow-up questions .

LEARN ABOUT: Behavioral Research

How to conduct a Qualitative Interview?

Conducting a qualitative interview requires careful planning and implementation to ensure that you gather meaningful and rich data. Here are some steps to consider when conducting a qualitative research interview:

Clearly define the purpose of your qualitative interview and the specific research method questions you want to address. It will help you design appropriate research interview questions and interview guides for your data analysis.

Identify the target population or specific individuals who can provide valuable insights related to your research questions. Consider criteria such as demographics, expertise, or experiences that align with your research methods and objectives. Use appropriate methods, such as purposive sampling of data collection, to recruit participants who can offer diverse perspectives.

Before conducting the interview, ensure that participants understand the purpose, procedures, and potential risks or benefits of their involvement. Obtain their informed consent, clearly explaining their rights as participants, including confidentiality and their ability to withdraw from the study at any time.

Prepare a flexible in depth interviews guide that includes a set of open-ended interview questions for an interview participant. The guide should be designed to elicit participants’ perspectives, experiences, and insights related to your research objectives for conducting interviews. Consider using probing techniques to encourage participants to elaborate on their responses and explore different dimensions of the topic.

Select a suitable location for the in depth interviews that is comfortable, private, and free from distractions for an interview participant. Create a relaxed and welcoming atmosphere to help participants feel at ease and encourage open communication for qualitative interviewing. Establish rapport and build trust with participants by introducing yourself, explaining the purpose of conducting interviews, and actively listening to their responses.

Start by asking introductory questions to establish a rapport with the participant. Follow the qualitative interview guide, but remain flexible and responsive to participants’ responses. Allow participants to speak freely and provide detailed answers, using probing techniques to delve deeper into their experiences, emotions, and perspectives. Take notes or record the interview (with participants’ consent) to capture accurate and detailed information.

Show respect for their experiences and perspectives, even if they differ from yours. Avoid making judgments or imposing your own beliefs during the interview. Create a non-judgmental and inclusive environment that encourages participants to share their thoughts and feelings honestly.

Transcribe the interview recordings or review your notes promptly after each interview while the details remain fresh. Analyze the qualitative data using appropriate methods, such as thematic data analysis, to identify patterns, themes, and insights. Ensure that the data is anonymized and handled following ethical guidelines.

By following these steps, you can conduct a qualitative research interview that facilitates rich and meaningful discussions, resulting in valuable data analysis for your research process.

LEARN ABOUT:   Research Process Steps

Types of Qualitative Interviews

The interview itself can be conducted over multiple formats. Qualitative researchers can employ several types of qualitative interviews based on their research objectives and the nature of the study. Here are some popular types of qualitative interviews:

types of qualitative interviews

Structured interviews involve a predetermined set of questions that are asked in the same order and manner to each participant. The questions of structured interviews are typically closed-ended or have limited response options. This type of interview is proper when researchers aim to collect specific information in a standardized way, allowing for easier comparison and analysis of responses across participants.

Semi-structured interviews combine predetermined questions with flexibility for additional probing and follow-up questions. Researchers have a set of core questions to guide the interview but can adapt the interview data collection process based on participants’ responses. This type of approach allows for a deeper exploration of participants’ experiences, thoughts, and perspectives while maintaining some standardization level.

Unstructured interviews involve open-ended questions and a free-flowing conversation between the interviewer and the participant. The interviewer may have a general topic or area of interest but allows the conversation to evolve naturally. Unstructured interviews provide a high degree of flexibility and allow participants to express themselves more freely, often leading to rich and nuanced data.

Each qualitative interview type has its strengths and is suited for different research purposes. Researchers or a research team should carefully select the appropriate type of research interview that aligns with their research objectives, the nature of the phenomenon under investigation, and the population being studied.

LEARN ABOUT:   Structured Question

Advantages of Using Qualitative Interviews

Qualitative interview techniques offer several advantages as a research method. Here are some of the key advantages:

A qualitative interview allows researchers to delve deeply into participants’ experiences, perspectives, and opinions. Using open-ended questions and probing techniques, researchers can uncover rich and detailed information beyond mere surface-level responses. This in-depth exploration provides a comprehensive understanding of the research topic.

Qualitative interviews offer flexibility in adapting the interview data collection process to the specific needs of each participant. Researchers can tailor their questions, follow-up probes, and overall approach based on the participant’s responses, allowing for a more personalized and engaging research experience. This flexibility enhances the quality and richness of the data collection.

Qualitative interview prioritizes the voices and perspectives of participants. Through interactive and conversational exchanges, participants can express their thoughts, emotions, and beliefs in their own words. This approach ensures that the research captures individuals’ nuanced and diverse experiences, offering insights that may not be obtained through other methods.

A qualitative research interview provides a holistic understanding of the social and cultural context surrounding participants’ experiences. Researchers can explore the factors influencing participants’ perspectives, such as cultural norms, societal expectations, or personal histories. This contextual understanding enhances the interpretation and analysis of the data, providing a comprehensive view of the research topic.

Qualitative interviews are particularly effective when studying sensitive or complex topics. It allows participants to share their experiences and emotions in a safe and confidential environment, facilitating a deeper exploration of potentially challenging subjects. This method also enables researchers to capture these topics’ nuances, contradictions, and subtleties, contributing to a more comprehensive understanding.

Qualitative research interviews can empower participants by giving them a voice and acknowledging the value of their experiences. By actively listening and engaging in meaningful dialogue, researchers validate participants’ contributions and foster a sense of ownership over their narratives. This empowerment can positively affect participants’ self-esteem, self-reflection, and personal growth.

Overall, qualitative interview provides researchers with a powerful tool to explore complex phenomena, gain in-depth insights, and understand the subjective experiences of individuals. By capitalizing on the advantages of this method, researchers can generate valuable and nuanced data that contributes to the advancement of knowledge in their respective fields.

Learn more by reading our guide: Types of Interviews .

Disadvantages of a Qualitative Interview

While a qualitative interview has many advantages, it is essential to acknowledge their potential limitations. Here are some of the disadvantages associated with qualitative interviews:

Qualitative interviews involve interaction between the researcher and participants, which introduces the possibility of subjective interpretations and biases. Researchers may unintentionally influence participants’ responses through questioning techniques, non-verbal cues, or personal beliefs. Researchers must be aware of their biases and take steps to minimize their impact on data collection and analysis.

The findings from qualitative research interviews are typically based on small sample size and specific context, making it difficult to generalize the results to a larger population. While qualitative research aims to provide an in-depth understanding, it may need more statistical representativeness than quantitative research methods offer. Therefore, when applying qualitative interview findings to broader populations or contexts, caution must be exercised.

Qualitative interviews can be time-consuming and require substantial resources. Conducting in depth interviews, transcribing data, and analyzing the qualitative data are labor-intensive tasks that require significant time and effort. Researchers must be prepared for qualitative interviews of a detailed and time-consuming nature, especially when working with large or diverse participant samples.

Ensuring the validity and reliability of qualitative research interviews can be challenging. Validity refers to the extent to which the interview data accurately represent participants’ experiences and perspectives, while reliability relates to the consistency and replicability of the findings. Factors such as interviewer bias, participant recall, and social desirability may compromise the validity and reliability of the data. Researchers must employ rigorous methodologies, triangulate data from multiple sources, and establish trustworthiness to enhance the credibility of their findings.

Qualitative interviews capture participants’ experiences and perspectives at a specific time and within a particular context. However, these experiences may evolve or change over time or in different contexts. Researchers must be mindful of the limitations of capturing participants’ experiences, recognizing that their findings may only partially represent the dynamic nature of human behavior and perceptions.

Despite these disadvantages, qualitative interviews remain a valuable research method that offers unique insights into individuals’ experiences and perspectives.

Learn About: Steps in qualitative Research

Qualitative interviews are valuable for gaining in-depth insights into individuals’ experiences, perspectives, and behaviors. They offer a unique opportunity to explore complex phenomena, uncover rich narratives, and understand the underlying meanings and interpretations that individuals assign to their experiences.

To summarize, Qualitative Research can either be a valuable tool to discover problems or help elevate any research programs with subjective data or leave researchers with amorphous and contradictory data. The key is to use the approach in combination with other qualitative and quantitative research techniques to enhance the depth of the data gathered.

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Qualitative data examples to ground your understanding

Last updated

14 February 2024

Reviewed by

Miroslav Damyanov

Or is there?

While numbers paint a clear picture, qualitative data adds depth and nuance, revealing a spectrum of perspectives that numbers alone can't capture. To truly harness the power of qualitative research , you must navigate this 'gray area' with precision, understanding not only what qualitative data is but also how it can unlock invaluable insights that shape strategies and outcomes in ways metrics alone cannot.

In this article, we will unravel the potential of qualitative data by delving into what it entails, effective collection methods, and its advantages and disadvantages.

Read on to explore the dynamics of qualitative research and data, with examples to ground your understanding and application.

  • What is qualitative data?

This type of data represents concepts, beliefs, and information not represented by numbers alone. They are insights gathered from people, usually in interviews and focus groups. 

Qualitative data can come from anywhere, including maps, photos, observations, diaries, and lab notes. However, it typically represents preferences, opinions, and beliefs from a subjective perspective, not rooted in numbers as you'd see with quantitative datasets.

Characteristics of qualitative data include:

Subjective: influenced by opinions, preferences, beliefs, and feelings

Open-ended: without limits or boundaries 

Descriptive: describing something in a non-judgmental manner

Detailed: shared accounts with details and sentiments

Non-numerical: not relating to numbers or currency

  • Importance of qualitative data

During your research endeavors, you'll collect data to help you understand the "what" and "how." Quantitative data, rooted in numbers, can help you.

Qualitative data will help you understand the "why," shedding light on the reasons and context behind actions. It will reveal why and how something occurred, pointing out behavioral or preference-based factors. These elements are essential to any research or project, especially those related to business and decision-making. Qualitative data can be extremely powerful in transforming your processes and methodologies.

Here's an example. An eCommerce store owner can see the quantitative data in sales reports that show which products are top sellers. But to understand why more customers bought a particular product, qualitative research is needed. Surveys or pop-up questions asking for product feedback can help the store owner learn the motivating factors behind the purchase. That qualitative data (the "why") helps the owner to make informed decisions about how to make other products more appealing.

  • Advantages of qualitative data

Researchers and teams turn to qualitative data for many reasons. It captures data you can't otherwise gather with quantitative research.

Key advantages of qualitative data include:

Explores behaviors beyond the numbers

Allows for in-depth attitude and preference analysis

Provides data-collection flexibility with interviews and focus groups, rather than predefined and structured variables

Offers a holistic understanding of unique projects and research

Encourages theory development and assessment

Provides affirmation and credibility

Appeals to exploratory research endeavors

Allows for observation in real-world scenarios

  • Disadvantages of qualitative data

As beneficial as qualitative data is for some projects, there are a few disadvantages to consider. Recognize the limitations of qualitative data so you can properly manage expectations and parameters.

The disadvantages of qualitative data include:

Sample sizes of groups or individuals can be an issue

Possible bias in the sample selection

Impartiality and data accuracy can be a challenge

Qualitative research is often more time-consuming

It's also hard to replicate datasets

There is potential for researcher bias

Qualitative data can be difficult to measure

Outliers can be over-emphasized

It lacks the structure commonly found in quantitative data

  • Types of qualitative data

Qualitative data typically falls into three categories:

Binary: organized into two categories, usually yes/no or true/false

Nominal: various data by category, with no meaningful association, like choosing colors or favorite movies

Ordinal: categories with a meaningful order but lacking a consistent interval between the categories, e.g. customer satisfaction ratings or levels of education

These data types can be collected through various research methods , including:

Case studies: researching a business application outcome

Focus groups: gathering insights from a test group of people

Observation: collecting data as an observer within an environment

Ethnography: studying people, cultures, and traditions

Narratives: evaluating people's stories and experiences

Interviews: seeking individual feedback and opinions

  • Methods of qualitative data analysis

There are five techniques to consider as you decide which research projects and business applications will benefit from qualitative data analysis. Based on your research objectives, explore which of these research techniques could be most effective:

Content analysis: examines the presence of subjects, words, and concepts

Narrative analysis: interprets stories, testimonials, and interviews

Thematic analysis: identifies, categorizes, and interprets data based on themes and patterns

Discourse analysis: studies the underlying meaning of qualitative data, including observations and context

Grounded theory analysis:  uses real-world data to develop theories

  • Examples of qualitative data

Explore these real-life examples of qualitative data resources and methods. Discover which might apply best to your projects and business model so you can learn more about the "why" and "how" of key experiences and processes.

Interviews 

Imagine your company has recently undergone significant structural changes, shifting employee responsibilities, or direction changes with a core offering. Research will determine if these changes are beneficial and will improve productivity and boost the company culture. As part of that research, you could gather qualitative data from employee interviews. 

These interviews seek to understand how employees perceive and experience the company changes. The qualitative data you could draw from their interview responses includes:

Common patterns related to challenges or shared experiences

Quotes or narratives that highlight employee perspectives

Emotional responses to the company change

Field notes 

If you're studying the dynamics of a particular community as part of an ethnographic project, qualitative data in field notes can be insightful. Whether you're studying interactions, cultural practices, or community events, the field notes are your primary method of data collection. 

Field notes can be used as part of your qualitative data analysis to uncover:

Observations from the field that highlight key aspects

Participation rates of community members

Interactions that support community identity

Textual data 

Some of the most common methods for collecting qualitative data are open-ended surveys. Including in-person paper surveys and anonymous or digital questionnaires, surveys are pivotal in how today's businesses and researchers learn about their industries and subjects.

Using open-ended questions, you can collect opinions, beliefs, and sentiments in the participants' own words.

These textual data responses are essential for:

Sentiment analysis

Contextual understanding

Identifying patterns and themes

Visual data 

Visual data in qualitative analysis can include photos and videos as the data collection method. For researchers who study the environment, for example, the visual data collected from field studies is pivotal. These visual perspectives can help researchers document changes, curate mapping, and spot challenges when comparing today's visuals to previous ones. 

When analyzing visual datasets, you can learn a host of details, including:

Symbolic interpretation

Spatial relationships

Visual patterns and themes

Any qualitative survey data collected over the phone would be an example of audio data. Researchers studying the experiences and perspectives of people with certain medical conditions might use these types of data collection methods. For instance, a researcher might record an interview with a participant, asking them to describe emotional or physical conditions.

Audio data can be great for analyzing more than just a participant's response. It can be used for:

Transcribing responses for reporting

Analyzing emotional tones and non-verbal cues

Narrative analysis of a person's complete journey

  • How to analyze qualitative data 

Once you’ve decided which quantitative data methods align best with your project or research goals, you'll need to collect and analyze the findings. To help make the most of your qualitative data responses, follow these five steps for in-depth analysis success.

Keep in mind that qualitative data analysis is an iterative process, requiring more flexibility than with numeric, quantitative data.

Step 1: Arrange your data

Gather your transcriptions, documents, notes, and interview responses. Sift through to separate the valid from the invalid, and arrange your data according to your demographics or pre-determined participant categories.

Step 2: Organize all your data

Mark the sources of your data and organize the notes and responses according to your research or project parameters. Sort the "yes" responses from the "no" responses.

Spend time reading (and rereading) the data to gain an in-depth understanding, keeping notes that may help you with the next step.

Step 3: Apply codes to the data collected

Create codes to guide the official categorization process. Make notes in the margins and use concept mapping and other approaches to help you code the various elements of your findings. Coding, or sorting themes and patterns, will help you evaluate the results in a more organized way.

Step 4: Validate your qualitative data

Using your codes, identify any underlying themes, opinions, language, or beliefs. Continued review of your codes may require some revisions but ultimately will help you funnel the data into themes and official categories of results. Researchers often leverage constant comparisons between new data and codes and existing ones. 

Step 5: Concluding the analysis process

Use your coded categories and themes to draw data-driven conclusions. You can then present your findings, along with the study's purpose and parameters, to key stakeholders .

The qualitative data analysis should tell a cohesive story that addresses pre-study questions and provides answers. Software solutions can help you develop final presentable findings.

  • Trust qualitative data to help your decision-making

Start tapping into the power of qualitative data to help you reach your research, business, and project goals. Knowing how to collect, analyze, and interpret these insights can be ground-breaking for your teams.

Having a deeper understanding of what qualitative data and research can offer will allow you to apply precision to your data-driven decision-making . And the insights gleaned from these datasets can revolutionize  how  you make those critical decisions, setting you up for success.

What are examples of good qualitative research questions?

These questions are great examples of open-ended qualitative research queries:

How would you describe your recent online experience?

Describe a time you experienced discomfort.

What areas of improvement would you suggest?

How can you avoid bias in qualitative research?

Several strategies can help you avoid introducing bias to your qualitative research project. These include:

Diversity in participant selection

Audit trails of decision-making

Triangulation of findings

Peer briefing before research

Reflexivity in acknowledging your biases and preconceptions

What are some quick-reference examples of qualitative data in action?

From software startups and scientific applications to backyard restaurant management and human resources oversight, there's a reason to explore qualitative research practically everywhere.

Here are a few more examples of qualitative data at work:

Location, origin, and gender collected for a census

Name, position, and event experience of a conference-goer for follow-up

Weight, height, and body types for a clothing size chart

User feedback about a newly launched software solution

Customer-experience survey responses to help improve a company's customer service policy

What are the core differences between qualitative and quantitative data?

While both quantitative and qualitative data provide value for research, there are primary differences between the two.

Quantitative data is fixed, countable, and related to numbers

Qualitative data is individualized, descriptive, and subjective

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  • Published: 12 February 2024

Experiences of delivering and receiving mental healthcare in the acute hospital setting: a qualitative study

  • Daniel Romeu   ORCID: orcid.org/0000-0002-2417-0202 1 , 2 ,
  • Elspeth Guthrie   ORCID: orcid.org/0000-0002-5834-6616 1 ,
  • Sonia Saraiva   ORCID: orcid.org/0000-0002-2305-9246 1 ,
  • Carolyn Czoski-Murray   ORCID: orcid.org/0000-0001-7742-2883 1 ,
  • Jenny Hewison   ORCID: orcid.org/0000-0003-3026-3250 1 &
  • Allan House   ORCID: orcid.org/0000-0001-8721-8026 1  

BMC Health Services Research volume  24 , Article number:  191 ( 2024 ) Cite this article

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Metrics details

Recent investment in UK liaison psychiatry services has focused on expanding provision for acute and emergency referrals. Little is known about the experiences of users and providers of these services. The aim of this study was to explore the experiences of users of acute liaison mental health services (LMHS) and those of NHS staff working within LMHS or referring to LMHS. A secondary aim was to explore the potential impact of a one-hour service access target on service delivery.

Cross-sectional qualitative study. Individual interviews were audio-recorded, transcribed verbatim and interpreted using framework analysis.

Service users reported mixed experiences of LMHS, with some reporting positive experiences and some reporting poor care. Most service users described the emergency department (ED) environment as extremely stressful and wished to be seen as quickly as possible. Staff described positive benefits of the one-hour access target but identified unintended consequences and trade-offs that affected other parts of the liaison service.

Conclusions

The assessment and treatment of people who attend ED with mental health problems needs to improve and particular attention should be given to the stressful nature of the ED environment for those who are extremely agitated or distressed.

Peer Review reports

The number of people attending emergency departments (EDs) in England has continued to rise, aside from the COVID-19 period. In 2019/20, there were 25.0 million ED attendances compared to 21.5 million in 2011/12 1 . In April 2022, waiting time performance in EDs was the worst recorded in modern data collections [ 1 ], and people with mental health problems had to wait substantially longer than those with physical health problems. Although mental health presentations decreased during lockdown, there was a bounce back post-lockdown with even greater numbers attending ED than before [ 2 ].

There are relatively few studies of people’s experiences of liaison mental health services (LMHS) in the UK. A recent internet survey of respondents’ experiences of LMHS in England showed that only 31% of service users found their contact with such services helpful [ 3 ]. Latent class analysis identified three types of experience; those who had a positive experience, those who reported a negative experience and those who were non-committal. Suggestions for improvement included the provision of a 24/7 service, reduced waiting times for assessment, and clearer communication about treatment or care post-assessment.

Prior studies of user satisfaction of LMHS in the UK have also been mixed [ 4 ]. One previous study which involved in-depth qualitative interviews with service users found that people complained about long waiting times before being able to access liaison services [ 5 ]. Some service users reported good experiences characterised by close collaboration between the service user and liaison practitioner whilst others described po or experiences.

In contrast with the UK, studies from Australia have reported positive service user experiences of LMHS with high levels of service user satisfaction [ 6 , 7 , 8 ]. In one study, service users reported timely access to being seen by a liaison practitioner and reported feeling listened to, understood and helped in a positive fashion, with an emphasis on problem solution [ 6 ].

All 170 hospitals in England with an ED now have at least a rudimentary LMHS [ 9 ]. These services have undergone substantial growth in the last seven years following significant investment from NHS England [ 10 ]. There has been particular expansion in acute services, and a “Core-24” service model has been developed, with staffing ratios based upon hospital size in terms of bed numbers [ 11 ]. These Core-24 teams usually consist of at least one liaison psychiatrist and several liaison mental health nurses. They focus on emergency work, providing 24-hour cover for EDs and acute ward referrals, with an emphasis on one-off assessments followed by signposting.

These new developments have been accompanied by rigorous performance targets for response times and throughput. In 2016, NHS guidance stated that a person experiencing a mental health crisis should receive a response from a LMHS within a maximum of 1 h of receipt of referral, and within 4 h the person should have received: “ a full biopsychosocial assessment if appropriate, and have an urgent and emergency mental health care plan in place, and as a minimum, be en route to their next location if geographically different, or have been accepted and scheduled for follow-up care by a responding service, or have been discharged because the crisis has resolved” [ 11 ]. Further review of access standards for mental health services in 2021 maintained the 1-hour target [ 9 ], although waiting time targets for all patients attending EDs are under review due to consistent and increasing failures to meet them.

While many hospitals have benefitted from the introduction of Core-24, especially where there were no or only rudimentary services previously, other established liaison services have had to change or modify their ways of working to meet targets. In addition to acute cover, these established services previously offered lower volume, higher intensity work involving the assessment, treatment and co-management of patients with complex physical and mental health problems seen in either inpatient or outpatient settings.

We previously completed interviews with 73 NHS staff from 11 hospital trusts in England who were either LMHS staff or worked closely with them and found that interviewees most valued being able to spend time with patients to carry out therapeutic interventions [ 12 ]. Some staff provided continued treatment for patients admitted to acute hospitals over several weeks. For example, in one service mental health nurses regularly visiting older adult patients or those on stroke wards to provide encouragement with eating and rehabilitation, both vital components of ensuring recovery. Teams with psychologists, therapists or mental health nurses trained in specific interventions (like cognitive behavioural therapy) offered brief interventions while the patient was admitted to an acute hospital bed, or a follow-up appointment after discharge. Staff reported problems with continuity of care across the secondary-primary interface; a lack of mental health resources in primary care to support discharge; a lack of shared information systems; a disproportionate length of time spent recording information instead of face-to-face patient contact; and a lack of a shared vision of care. Similar issues were identified across different liaison service types.

The aim of the present study was to better understand the experiences of users and providers of LMHS, and to explore hospital staff’s experiences of the changes brought about by the NHS England’s investment in Core-24 and any impact on patient care. We were particularly interested in improving our understanding of the mechanisms and trade-offs involved in relation to meeting one key performance target, the one-hour response time set by NHS England for LMHS. Recent programme theory suggests that the imposition of such fixed targets may have unintended consequences for liaison services and other parts of the health care system [ 13 ].

This work formed part of the first phase of a programme funded through the NIHR Health Services and Delivery Research scheme to evaluate the cost-effectiveness and efficiency of different configurations of liaison psychiatry services in England (LP-MAESTRO) [ 14 ]. The Consolidating Criteria for Reporting Qualitative Research (COREQ) guidelines [ 15 ] have been followed.

This was a cross-sectional qualitative study with service users of hospital-based LMHS and hospital staff with either experience of working in, or working closely with, LMHS.

Setting and sample

Service users were recruited from two Northern cities in England. We aimed to recruit 8–10 service user participants and developed a purposive sampling frame to ensure maximum variation. Potential participants were approached by either LMHS staff to determine their interest, or by local service user organisations who were invited to identify participants for the project through their own contacts. Once consent to contact had been provided by the service users, they were contacted directly by a member of the research team, who explained the study and provided a study information sheet. The potential participant was given at least 48 h to decide whether to participate. All participants provided written informed consent and there were no dropouts. No relationship was established with participants prior to study commencement. Participants were not informed of any of the interviewers’ personal goals for conducting the research.

Hospital staff were recruited from two hospitals in Northern England, both with EDs and within the same city. A maximum-divergence sampling frame was developed to maximise diversity according to professional background, sub-specialism within the LMHS, clinical or managerial focus and whether liaison team member or referrer to the service. Overall, we planned to recruit 8–10 staff participants. All staff participants provided written informed consent and there were no dropouts.

Data collection

Service users.

Nine service users were individually interviewed using a semi-structured topic guide. The service user topic guide was developed for this study (LP MAESTRO) and not published elsewhere (see Additional file 1 ). It consisted of a list of key topic areas with open-ended questions and additional prompts covering the following areas: introductory questions identifying the contact the participant had had with acute care; experiences of the acute care received from acute hospital staff; accounts of care received from LMHS staff; and views on desirable changes and ways to achieve them. They were not asked specifically about Core-24 developments, as it was unlikely that they would be familiar with such policy and staffing changes. However, staffing and waiting times were included as part of the topic guide.

Hospital Staff

Eight hospital staff were individually interviewed using a semi-structured topic guide. The hospital staff topic guide was adapted from an earlier topic guide used in the LP-MAESTRO study in relation to a previous investigation of liaison psychiatry and hospital staff experiences of liaison services [ 12 ]. The adapted topic guide, which focuses primarily on staff experiences of CORE-24 is provided in Additional file 2 . The following key topic areas were covered: introductory questions about the staff member’s work history and the nature of their involvement with LMHS; experiences of LMHS prior to introduction of Core-24; description of any changes resulting from Core-24; impact of these changes on the service; impact on patient care; and views on how the service could be improved.

Interviews lasted 30–90 min and took place via telephone between September 2017 and February 2019. Participant interviews were conducted first, followed by interviews with hospital staff. With permission all interviews were audio-recorded and transcribed verbatim. There were no repeat interviews. Transcripts were not returned to participants for comment or correction. Only the interviewer and participant were present at each interview. No field notes were recorded.

Interviews were conducted by three researchers, all from the Leeds Institute of Health Sciences and qualified by experience and training (CCG, SS, EG). None were involved in the delivery of acute LMHS at the time of the study. EG is a female Professor of Psychological Medicine and Consultant Psychiatrist. CCM is a female Senior Research Fellow and SS is a female Research Fellow. EG had previously worked in an acute liaison mental health team and was generally supportive of the Core-24 developments prior to the study. Neither SS nor CCM had a priori views or identified biases. The form and content of the topic guides were developed in collaboration with people with personal experience of mental health problems and accessing LMHS.

Data analysis

The semi-structured interviews were interpreted independently by DR and EG using framework analysis [ 16 ]. This is a qualitative method that is useful in research that has specific questions, a limited time frame and a pre-determined sample; it is therefore well-suited to applied policy research. First, DR and EG independently read all transcripts with the study’s aim in mind. Each then independently reviewed all transcripts line by line identifying relevant experiences, opinions, descriptions of incidents and emotions (codes). DR collated codes into a draft theoretical framework which was refined through discussion with EG. It became apparent to base several framework categories around the key areas of interest in the interview schedule as we wanted to be open to issues arising from the data. DR then matched the data to the provisional framework. Each example was independently included under one or more theme in the thematic chart by DR and EG who then met to resolve any disparities. In the final stage, findings were reviewed by AH. Relevant supporting quotations were then extracted from interview transcripts to illustrate each theme and sub-theme. Data from service users and staff were analysed separately but are presented together if relevant to the theme or sub-theme. Participants were not asked to provide feedback on the findings.

Sample characteristics

Seventeen in-depth interviews were conducted, nine with LMHS users and eight with healthcare professionals. Service user participants consisted of 3 men and 6 women with varying age ranges (Table  1 ). Presenting problems included self-harm, psychosis, mania, long-term physical health problems and medically unexplained symptoms. The interviewed professionals were mental health liaison nurses ( n  = 3), consultant liaison psychiatrists ( n  = 2), general nurses ( n  = 2) and one consultant in emergency medicine.

Main findings

Participants discussed a range of topics surrounding the provision and experience of mental healthcare in general hospitals. They illustrated the complexity involved in meeting mental health needs in this setting. Below we outline our findings in terms of themes and sub-themes that emerged from the interviews; the four themes and their constituent subthemes are summarised in Table  2 . The staff topic guide included specific questions about Core-24 that were not included in the service users’ topic guide, so most of the sub-themes around the Core-24 service standard are only relevant to staff participants.

Theme one: the emergency department (ED)

Healthcare professionals and service users discussed their views of the ED as a site for mental healthcare provision. The content of their discourse comprised the sub-themes of ED staff, physical environment, appropriateness for mental health problems and desired characteristics.

Service users recounted highly variable experiences of ED staff when seeking help for their mental health problems. Some were described as kind and compassionate people who acknowledged distress and evoked feelings of validation:

“ They recognised I wasn’t putting things on, that I did feel acutely suicidal as I was saying ” – Participant 1.

Others disclosed negative views of ED staff, describing them as unpleasant and harsh. Three participants reported that ED staff withheld treatment that they thought was needed. Others reported that staff did not allow the service user to speak and failed to provide any guidance or support on discharge.

“The GP referred me to A&E and when I arrived there, they were very very harsh” – Participant 6.

LMHS professionals generally had negative perceptions of ED staff, reporting that they had poor psychiatric knowledge and skills. Several felt that ED staff did not appreciate the role of LMHS and frequently made inappropriate referrals. Some suggested that ED staff had little interest in mental health problems:

“I think sometimes they don’t ask more questions about mental health, and I don’t know if that is because they don’t feel confident to, or they just don’t want to” – Participant 13.

Physical environment

The ED environment was discussed exclusively by service users, and their opinions were overwhelmingly negative. Common issues were that the assessment room was uncomfortable and small:

“You’re brought into this really small room with no windows, it was tiny, it was also not necessarily painted, it was very scruffy ” – Participant 5.

A lack of provision of refreshments contributed to a sense of discomfort. The privacy of the assessment environment varied; two individuals reported that they were assessed in a private space, and one was not:

“In the department with just a curtain pulled around, so it wasn’t very private” – Participant 1.

Appropriateness for mental health problems

Both service users and providers questioned the appropriateness of the ED for people with mental health needs. No participants felt that the ED was an appropriate place for these needs.

“A lot of them are quite vulnerable, and more at risk of accidental self-harm or sort of vulnerable from other people in the department and it’s A&E isn’t it, I wouldn’t it consider a very nice environment for people that are experiencing psychosis” – Participant 13.

Service users described their experiences of seeking care in the ED as anxiety-provoking and lonely. They acknowledged that attending the department was an undesirable last resort, only done when other services and professionals could not be accessed in the community.

“It’s not the best solution by any stretch of the imagination but, but it’s the only place that’s available” – Participant 8.

Desired characteristics

Participants suggested ways that the ED could be improved to better care for those with mental health needs. These included a more comfortable environment, the option to wait outside, better communication of next steps and knowledge of community-based support. One participant suggested the provision of company while awaiting input from the mental health team.

“I don’t know what else they could do apart from have somebody sit with you all the time until the psychiatrist came or somebody to assess you” – Participant 7.

Liaison practitioners also felt that the ED could be improved by providing more staff training in mental health assessments and improving referrals to the LMHS. This could reduce the volume of referrals and facilitate referral triage while reducing wait times for service users.

“If you upskill the ED people to even basic then liaison psychiatry should be able to turn down referrals… And we have to remember in the middle of all of this is a patient” – Participant 15.

Theme two: Liaison mental health services (LMHS)

The second theme refers to participants’ views and experiences of liaison mental health services (LMHS). There are three sub-themes: experiences of LMHS, barriers to contact and desired characteristics.

Service users described variable experiences of the help they received from LMHS. Contact with LMHS helped some individuals to feel more comfortable and to understand the next steps. Some described a therapeutic benefit of talking in depth about their issues:

“It helps me mental health, being able to talk about it and stuff” – Participant 3.

Others voiced that LMHS were either unhelpful or contributed to them feeling worse. This was related to the feeling of not being listened to and the perception that no tangible help or support was offered.

“ I’ve not got time for them as they do nothing for me” – Participant 9.

Some service users held the view that LMHS complete little more than a “box-ticking” exercise that offers little benefit to the service user. This was echoed by one of the physical healthcare professionals.

Common problems were that the professionals seemed rushed and incompetent. Three participants shared the view that LMHS staff were dismissive or disinterested. This led them to feel guilty and as though they had wasted the professional’s time.

“Sometimes the mental health staff can be very dismissive and treat me like I’ve just wasted everybody’s time, and I should have just looked after myself at home” – Participant 8.

Others described LMHS staff in a more positive light, reflecting that they allowed them to speak freely while listening carefully and acknowledging their needs. In some interviews, LMHS staff were described as caring and comforting. One participant felt that LMHS staff are underappreciated:

“I know with my experiences with liaison psychiatry that they do a lot more than people may think” – Participant 4.

Generally, interviewed professionals were complimentary towards LMHS staff, describing them as hard-working, knowledgeable, experienced, accessible, and committed to high-quality patient care. Participants had conflicting views on whether LMHS staff have a good relationship with the ward teams and whether they meet their expectations, although this was often attributed to a rise in demand for the service.

Barriers to contact

Participants discussed barriers to accessing LMHS. Some service users recounted how input from LMHS was postponed or withheld because they were under the care of a community mental health team. This sometimes resulted in interactions with a “diversion team”, which was described as a frustrating, obstructive experience.

“You just can’t get past diversion because they’ve been put in place to stop people like me who are known to the system… They’re basically there to go, ‘there, there, you’re ok, you go home and speak to your care coordinator tomorrow.’” – Participant 8.

Staff felt that significant barriers to contact with LMHS included insufficient staffing levels, particularly out of hours, and a seemingly excessive amount of time completing documentation.

“The [LMHS] team spend a long time writing things up and reporting… If we do make a referral for later in the evening or overnight, I don’t work nights, but they’re often told, ‘oh we can’t come and see the patient because we’re writing up our reports!’” – Participant 12.

Service users outlined factors that would improve their experience of receiving care from LMHS. Several participants described dissatisfaction with being discharged without a clear treatment plan and called for the provision of aftercare and more information about third sector organisations.

“If someone’s self-harming or whatever they shouldn’t just be discharged. They need aftercare and everything. It should be in their care plan.” – Participant 2.

Some described desirable characteristics of LMHS staff, which included compassion, knowledge, and clearer communication of delays and anticipated next steps. Service users expressed a desire to be treated as an individual and to be listened to attentively.

“You need front-line staff who have the personal interactive skills to acknowledge, to offer comfort and explain what is going to happen, not front-line staff who make you more agitated or that they are confused” – Participant 5.

Other desirable characteristics of the service identified include universal service provision across the country, a switch of focus from medications to psychosocial interventions, and a separate service for those who do not meet the criteria for admission but who feel unsafe to return home. Some service users voiced support for an acute mental health service separate from the ED.

Theme three: core-24 service standard

This theme encapsulates views towards the Core-24 service standard and the subthemes are the 1-hour wait, perceived benefits, unintended consequences , and policymaker detachment.

1-hour wait

Although professionals acknowledged the importance of targets, many felt that the one-hour target was unattainable, particularly for those with complex presentations or substance issues. Some felt that it was inappropriate to assume that service users’ needs are constant throughout the day. There was a consensus that immediacy was prioritised over clinical importance, which manifests as brief introductions within the hour instead of careful, comprehensive assessments.

“It’s not about how quickly you are seen, it’s about the quality of the interaction and I think if you are having to respond to patients in an hour that can sometimes compromise the quality” – Participant 16.

In contrast, service users almost universally expressed a wish to receive contact from the LMHS as soon as possible, and even a one hour wait felt too long to wait if someone was very distressed.

“When you are thinking of taking your own life, an hour is a lifetime” – Participant 1.

Perceived benefits (staff only)

The most salient benefit reported by the healthcare professionals was investment in the LMHS. They described more financial investment into the service, and the creation of staff posts to expand the workforce, contributing to feelings of reassurance and comfort. Although participants acknowledged the associated challenges of training new staff, overall, this change was perceived as positive.

“The investment within the services has enabled us to, erm you know, to broaden out what we do” – Participant 17.

Generally, professionals explained that the service standard improved patient flow. They felt that one-hour reviews were conducive to faster discharges and the prevention of unnecessary hospital admissions. They also reported a greater focus on the service user experience and acknowledged the target as an opportunity to improve the service further.

“I think that’s been a huge positive for the team because it’s made them think, actually, okay, we need to do this. How are we going to do it in the best way possible to get the service users experience and the standard of care for them as best as we can?” – Participant 14.

Unintended consequences (staff only)

Professionals also reported numerous undesired sequelae to the Core-24 one hour target. The first was that the target acted as an incentive for people to use the ED for their mental health needs in the knowledge that they would be seen quickly. This contributed to a rise in the clinical workload for both ED and LMHS staff.

“It was an odd thing to do when you’re trying to decrease attendances, it’s like a bit of an incentive to [attend the ED]” – Participant 11.

Some explained that the target had a detrimental impact on servicing providing ward cover, as LMHS staff are diverted from wards to the ED for initial reviews for new presentations. This results in delays on the wards and subsequently prolongs admissions.

“They used to see people who were in the beds before the parvolex (a treatment following a paracetamol overdose) ended, but they’re just unable to do that now because of the amount of people in A&E to be seen” – Participant 10.

The target has also had ramifications on working hours, with some participants reporting that their shifts were extended from eight to twelve hours, resulting in more lone working and reduced staff morale. This was identified as the reason for some staff members deciding to leave their jobs.

Policymaker detachment (staff only)

Generally, professionals felt that Core-24 was implemented poorly by policymakers and commissioners who were disconnected from the service. They described that no attempts were made to seek the views of clinicians, and that it was delivered as a compulsory change.

“The way that this change was brought in was very top-down, there was very little engagement with the team” – Participant 16.

One professional reported that they were informed with little notice that older people would be included in the remit of LMHS following the standard, and they received no formal training for this. The disconnect between policymakers and clinicians resulted in resentment among staff.

Service users echoed this idea by suggesting that policymakers were detached from the views and priorities of those seeking care. Some mentioned that these should be incorporated into decisions about LMHS provision:

“I think that the service should get more involvement from the service user’s experience” – Participant 6.

Theme four: stigma of mental illness

The final theme describes the stigma associated with mental health problems. The subthemes were discrimination and the mental-physical dichotomy .

Discrimination

Service users commonly felt discriminated against for having mental health problems. They described being treated differently to those with physical health problems, with their issues not being taken as seriously. Some recalled being dismissed and feeling guilty for accessing services.

“If you’re physically ill that counts, it’s given a higher priority over mental illness” – Participant 4.

Professionals also acknowledged the discrimination against those with mental health problems in the general hospital setting. They commented that service users with mental health needs are generally perceived as problematic and unwanted in the ED.

“Patients with mental health difficulties in the emergency department are the difficult ones, the bad ones, the ones that upset the data, or the ones that don’t move out quick enough” – Participant 15.

The mental-physical dichotomy

This subtheme describes the clear delineation between physical and mental health in the context of healthcare services. Both professionals and service users commented that mental health needs are frequently neglected in physical healthcare settings. This is attributed to a perceived unwillingness to enquire about psychiatric symptoms and a tendency to ignore biopsychosocial determinants of health.

“If I was to mention mental state, your consultants turn their faces away from me” – Participant 9.
“The traditional method of dealing with a lack of liaison psychiatry in the general hospital is to ignore the problem and just pretend it’s not there, to not notice that the patient is sad, not notice that they are anxious, to blame the patient, to discharge them early, to not take care of the wider side of psychosis difficulties that have prompted this admission” – Participant 15.

Clinicians also perceived a divide between mental and physical healthcare professionals. Some LMHS staff felt that ED clinicians had poor psychiatric knowledge and skills, that they often made inappropriate referrals with minimal information, and that their service was not understood or appreciated.

“I don’t think mental health is respected within the A&E department as a proper profession” – Participant 13.

Final analysis

The final stage of analysis is summarised in Table  3 , which shows comparisons across the service user and staff groups whilst also reflecting the strength of the signals from the data (determined by the proportion of participants who voiced these opinions). It shows some striking differences in patterns but also several areas of agreement. The one-hour access target is seen differently by service users and staff whilst issues related to stigma are perceived as important by both groups.

How our results compare

There are relatively few qualitative studies of LMHS, so this study is an important addition to the field. The variable experiences of LMHS users in this study are similar to those described by Eales and colleagues [ 5 ] and consistent with the recently published online survey of LMHS users [ 3 ]; some people reported good treatment and care from LMHS, whilst others report poor care and an unhelpful experience. Despite the increased funding for LMHS in recent years, people’s experiences remain patchy and well below the satisfaction levels reported by users of services in Australia [ 7 , 17 , 18 , 19 ]. However, it is difficult to compare services between countries with different healthcare systems.

Most service users felt that the ED environment contributed to additional stress and was an inappropriate place for people with acute mental health problems. This is consistent with previous studies [ 20 , 21 ], which have highlighted the negative and stressful aspects of the ED for people with mental health issues and described the ED as overstimulating and lacking in comfort and privacy. This is set against a backdrop of a recent survey carried out by the Royal College of Psychiatrists which reported that more than three quarters of people referred to mental health services resort to using emergency services because their mental health deteriorates whilst waiting for an initial assessment [ 22 ].

Wait-time targets

Opinions about the appropriateness and helpfulness of the one-hour performance target for LMHS varied between service users and staff. Service users highlighted the importance of being seen as quickly as possible in ED, particularly because the environment was stressful, but also because they were in a heightened state of distress and needed urgent relief. Some staff, however, believed the one-hour target distorted clinical practice with performance taking precedence over clinical need. This resulted in many unintended consequences including encouraging an increase in mental health ED attendances and a detrimental effect on other parts of the liaison service.

These findings support a logic model we previously developed to explain the impact an increase in liaison mental health provision may have on specific target response times [ 13 ]. Increased staffing levels initially enable LMHS to see more service users within the designated response target time, but various tensions and trade-offs within the system become apparent over time. If more service users attend ED due to the quicker response time, coupled with long waits in the community, pressure on the system increases again. This pressure causes a tension between the balance of ED work and the needs of patients with severe mental health problems who are inpatients in the acute hospital. The focus on ED and meeting the response target may result in potential disruptions to the care of hospital inpatients with deleterious clinical consequences and increased length of hospital stays. The introduction of a response target inevitably leads to unintended consequences in other parts of the healthcare system; the balance of advantages and disadvantages of the target across the whole system needs to be considered.

Public stigma and discrimination against people with mental illness is not a new phenomenon and is still widespread in society [ 23 ]. A review of 42 studies of ED staff attitudes towards service users presenting with mental health problems, 14 of which were conducted in the UK, reported widespread perceived negativity, although positive experiences were also acknowledged [ 24 ]. The findings from our study suggests negative attitudes towards people with mental health problems are still problematic in the ED setting. A recent qualitative systematic review exploring stigma and discrimination experienced by mentally ill individuals seeking care for physical and mental health concerns suggests that stigma and discrimination significantly compromise the quality of healthcare relationships with services users [ 25 ].

What can be done?

The Royal College of Emergence Medicine has produced a useful toolkit for improving care of people with mental health problems whilst in the ED, which stresses that all people with either a physical or mental health problem should have access to ED staff that understand and can address their condition [ 21 ]. There is a clear driver from both the Royal College of Emergency Medicine and the Royal College of Psychiatrists to improve the care of people with mental health problems who attend ED. There has also been recognition of this problem by NHS England with funding in 2017–2018 of £18 million for 234 winter mental health schemes to help alleviate pressures in ED for people with mental health problems [ 26 ]. Most of the funding was allocated to mental health liaison schemes, community crisis resolution and discharge and step-down schemes. Although many individual schemes reported local positive benefits, there were no robust evaluations which would support national rollout of any of these schemes.

There is some evidence that small positive attitude changes towards people with mental illness can be achieved by specific stigma reduction interventions [ 27 ], although relatively few interventions have been evaluated in the ED. Most educational interventions have focused solely on knowledge acquisition for specific conditions such as substance misuse disorders [ 28 ]. However, the endemic nature of stigma towards mental illness suggests that multi-level changes are required at organisational and personal levels. The Lancet Commission on ending discrimination in mental health included a review of all forms of stigma and discrimination against people with mental health conditions in all settings and societies globally [ 23 ]. The authors made several recommendations including policy and societal changes and workplace changes. Of relevance to the ED setting, they recommend that all healthcare staff receive mandatory training on the needs and rights of people with mental conditions, co-delivered by people with lived experience of mental health issues.

The staffing recommendations for Core-24 LMHS were largely based upon the size of hospital and the knowledge that mental health issues account for 4% of ED attendances. However, recent work suggests a further 4% of ED attendances consist of people attending with a physical health problem but who also have significant mental health issues [ 2 ]. This suggests that current LMHS staffing levels need to be reviewed, as Core-24 guidance may have underestimated the workload demands on LMHS, and workload is better estimated by patient throughput than the size of the hospital in terms of bed numbers or the presumed percentage of people in ED who may require liaison services [ 29 ].

Strengths and limitations

This study has several strengths. First, we met our recruitment targets, although, recruitment of service users took longer than we anticipated. There are no patient organisations that represent liaison service users, so recruitment can be challenging. However, we achieved a wide diversity of service user participants in terms of demographic characteristics and clinical problem areas. The most common clinical problems seen by liaison services in England are co-morbid physical and mental health problems, self-harm and cognitive problems [ 29 ]. Participants with co-morbid physical and mental health problems were represented in our participant sample. However, service users with cognitive problems were excluded from this study due to the inability to provide informed consent to participate. Second, the staff participants came from a range of professional backgrounds, including those who worked within LMHS and those who referred to LMHS. Third, we were able to explore both service user and staff perspectives about an important aspect of current service provision – the one-hour access target.

There were several limitations to the study. First, our sample size was relatively small and service user participants were only recruited from two geographical areas, and hospital staff from only two hospitals. We required members of staff who had experience of LMHS both prior to and subsequent to the introduction of Core-24, which limited the number of staff who we could interview and were willing to participate in the study. This also limited our ability to interview to the point of saturation. A larger staff sample may have resulted in other themes emerging so the findings of this study cannot therefore be generalised to other services in England, although many of the findings do accord with previous work in this area. Second, as discussed above, we were unable to recruit people with cognitive problems, making findings less relevant to liaison services for older adults. Third, interviews with participants and staff were conducted before the COVID-19 pandemic and its impact upon healthcare delivery. There was a marked drop-off in ED attendances during lockdown and the many liaison ED services were moved to other parts of the hospital to minimise spread of infection. Although there has been a clear bounce back in ED attendances among people with mental health problems post-pandemic [ 2 ], it is unclear to what extent services and service users have changed.

This study provides compelling evidence that the assessment and treatment of people who attend ED with mental health problems needs to further improve. The negative staff attitudes described are unacceptable, services for aftercare following assessment are inadequate, and the immediate experience in ED is often negative.

Particular attention should also be given to the stressful nature of the ED environment for those who are agitated or distressed. It can be argued that the ED is not the most appropriate place for people with acute mental health needs, but at present, there is often no clear alternative. Diversion schemes are under development in some areas. However, there will always be a need for many people with mental health problems to attend ED, as people with mental health issues commonly also have physical health problems, which require investigation and management in parallel with their mental health difficulties. Whilst ED service users emphatically support the one-hour response target, the imposition of such targets can have unintended consequences on other parts of the liaison service which need to be balanced to ensure parity for LMHS users in ED and those admitted in the acute hospital as inpatients.

Availability of data and materials

Data from this study are not available due to the qualitative nature of the study.

Abbreviations

Liaison Mental Health Service

Emergency Department

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This project is funded by the National Institute for Health Research (NIHR) HS&DR programme (project reference 13/58/08). The work was also supported by a legacy provided by the family of Dr James Haigh. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

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AH, JH and EG conceived of the research. AH was the programme lead. CCM, SS and EG conducted the interviews. DR and EG conducted the analysis. DR and EG wrote the first draft of the manuscript. All authors (DR, EG, SS, CCM, JH, AH) contributed to the manuscript. All authors have read and approved the final manuscript.

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Romeu, D., Guthrie, E., Saraiva, S. et al. Experiences of delivering and receiving mental healthcare in the acute hospital setting: a qualitative study. BMC Health Serv Res 24 , 191 (2024). https://doi.org/10.1186/s12913-024-10662-4

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  • Liaison psychiatry
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BMC Health Services Research

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qualitative research with interviews

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Usefulness of pedagogical design features of a digital educational resource into nursing home placement: a qualitative study of nurse educators’ experiences

  • Monika Ravik   ORCID: orcid.org/0000-0002-1490-9341 1 ,
  • Kristin Laugaland   ORCID: orcid.org/0000-0003-3451-2584 2 ,
  • Kristin Akerjordet   ORCID: orcid.org/0000-0002-4300-4496 2 , 3 ,
  • Ingunn Aase   ORCID: orcid.org/0000-0002-0243-6436 2 &
  • Marianne Thorsen Gonzalez   ORCID: orcid.org/0000-0003-1208-5470 1  

BMC Nursing volume  23 , Article number:  135 ( 2024 ) Cite this article

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The rapid advancement of technology-enhanced learning opportunities has resulted in requests of applying improved pedagogical design features of digital educational resources into nursing education. Digital educational resources refers to technology-mediated learning approaches. Efficient integration of digital educational resources into nursing education, and particularly into clinical placement, creates considerable challenges. The successful use of digital educational resources requires thoughtful integration of technological and pedagogical design features. Thus, we have designed and developed a digital educational resource, digiQUALinPRAX, by emphasizing pedagogical design features. The nurse educators’ experiences of the usefulness of this digital educational resource is vital for securing improved quality in placement studies.

To obtain an in-depth understanding of the usefulness of the pedagogical design features of a digital educational resource, digiQUALinPRAX, in supporting nurse educators’ educational role in nursing home placements in the first year of nursing education.

An explorative and descriptive qualitative research design was used. Individual semi-structured interviews were conducted with six nurse educators working in first year of a Bachelor’s of Nursing programme after using the digital educational resource, digiQUALinPRAX, during an eight-week clinical placement period in nursing homes in April 2022.

Two main categories were identified: (1) supporting supervision and assessment of student nurses and (2) supporting interactions and partnerships between stakeholders.

The pedagogical design features of the digiQUALinPRAX resource provided nurse educators with valuable pedagogical knowledge in terms of supervision and assessment of student nurses, as well as simplified and supported interaction and partnership between stakeholders.

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Contributions of the paper

What is already known.

The educational role in clinical placement education poses substantial challenges for nurse educators, such as tailoring pedagogical approaches to the learning needs and abilities of individual students.

Digital educational resources are increasingly used in clinical placement education in nursing to enhance student learning.

To improve the quality of clinical placement learning for student nurses, attention should be paid to the design, development, and use of digital educational resources.

What this paper adds

This paper adds that nurse educators experienced that pedagogical design features of a digital educational resource, digiQUALinPRAX, provided them with valuable knowledge in supervising and assessing student nurses in clinical placement education in nursing homes.

This paper further adds that nurse educators experienced that the pedagogical design features of the digital educational resource, digiQUALinPRAX, were supportive and enhanced their role by providing possibilities for interaction and partnership between stakeholders in nursing home placement.

Nursing homes hold great potential as clinical learning arenas for first year student nurses; thus, improved quality in these clinical placement studies is crucial [ 1 ]. To provide optimal and high-quality clinical placement education and benefit from the nursing home learning potential, nurse educators play a key role in their supervision and assessment approaches [ 2 ]. Thus, nurse educators’ pedagogical approaches during clinical placement education entails meeting different levels of students’ individual learning needs and preparedness for learning [ 3 ]. From this perspective, nurse educators’ competence, engagement, pedagogical practice and experience might motivate or demotivate student nurses early on in their education, both directly and indirectly, for their future careers working with elderly in the nursing home context [ 4 ]. However, in nursing homes as an important learning context, recruiting registered nurses filling roles as students’ clinical supervisors is often a challenge [ 5 , 6 ].

Nonetheless, supervising student nurses during placement education in nursing homes is reported to be a low priority among nurse educators [ 5 ]. Additionally, nurse educators in nursing homes frequently lack the formal preparation to fulfil their educational role at the expected educational level [ 5 , 7 ], and are often hired to act as nurse educators for a short time during placement education [ 5 ]. Consequently, part-time nurse-educators will lead to a lack of continuity in student follow-ups [ 5 ]. Thus, addressing improved quality in clinical supervision and assessment in the Bachelor’s of Nursing Education Programs is vital [ 8 , 9 ].

Tailoring pedagogical approaches to students’ individual learning needs pose substantial challenges for nurse educators [ 10 ]. Thus, supporting and enhancing nurse educators’ proficiency in supervising student nurses during placement education in nursing homes for pedagogical purposes has been suggested; this should be done using digital educational resources [ 8 ]. The present study responds to this request.

The use of digital educational resources has been increasingly developed owing to the extensively available and easily accessible internet connection [ 11 ]. These resources could be electronic (e-learning), mobile (m-learning), and online and game-based learning [ 12 , 13 , 14 , 15 ]. Digital educational resources are innovative educational approaches to provide knowledge in an interactive and flexible environment, thus facilitating personalised learning and improved understanding [ 16 , 17 ]. Digital educational resources aimed at ensuring that student nurses have appropriate learning opportunities and that experiences are increasingly being used [ 18 , 19 , 20 , 21 , 22 ].

However, integrating digital educational resources in various educational institutions goes beyond easy and flexible access to these learning resources. Koehler and Mishra [ 23 ] underline the need to effectively utilise these resources for educational purposes. Thus, there is a need for educators to improve their understanding of using digital educational resources when teaching, supervising, and assessing to optimally enhance students’ learning experiences [ 23 , 24 ]. Nurse educators are often underconfident and unable to optimally use digital resources, and thus are unable to understand how to modify their pedagogical approaches digitally [ 10 , 16 , 17 , 25 ]. A recent review has reported that digital educational resources in nursing education often lacks anchoring in pedagogical theories [ 26 ]. Consequently, this will directly affect the quality of education provided to student nurses [ 16 ]. To compensate for the above mentioned shortcomings, we designed and developed a digital educational resource, digiQUALinPRAX. This resource aims to support nurse educators in developing suitable and theoretically anchored pedagogical knowledge that is adapted to student nurses during nursing home placement [ 8 ]. The co-creative process informed the educational content, design, and functionality of the digiQUALinPRAX resource, which were informed by and grounded in learning theory and principles, in line with Koehler and Mishra’s [ 23 ] ‘Technological pedagogical and content knowledge’ framework. Technological knowledge refers to knowledge of the technological characteristics, whereas pedagogical knowledge refers to how students learn best, and content knowledge refers to the domain-specific subject matter that is being taught and learned [ 23 ]. Koehler and Mishra [ 23 ] emphasise the necessity of interrelatedness and dynamic interplay between content and pedagogical and technological knowledge to effectively cater to students’ learning needs. Here, technological pedagogical knowledge refers to knowledge about the use of technology to optimally implement pedagogical approaches (i.e. the use of digital educational resources as a vehicle for the learning outcomes and experiences desired by an educator) [ 23 ].

This study aimed to obtain an in-depth understanding of how nurse educators experienced the usefulness of the pedagogical design features of the digiQUALinPRAX resource to support their role in nursing home placements. Experiences enables the identification and addressing of any issues that require improvement before the final version of a digital educational resource is released, resulting in a better pedagogical experience for nurse educators [ 27 ]. When exploring experiences about digital educational resources, experiencing educators’ feedback is crucial. This is because they have the pedagogical competence and experience necessary to create resources that align with curriculum goals [ 28 ].

The current study applied an explorative and descriptive qualitative research design. This is appropriate for investigating an unexplored subject descriptively, along with its characteristics [ 29 ]. The study is part of a larger research project [ 8 ] that developed the digiQUALinPRAX resource. The digiQUALinPRAX resource was co-created with key stakeholders (i.e. student nurses, nurse educators, registered nurse mentors, e-learning designers and researchers) to enhance quality in nursing home placements, including the support and enhancement of the nurse educators’ role. For a detailed description of the overall co-creative development process, see Laugaland et al. [ 30 ].

Educational placement context

In Norway, becoming a registered nurse requires the successful completion of a 3-year Bachelor’s curriculum programme (180 credits), developed in accordance with the European Directive [ 31 ] and national regulations [ 32 ]. Half of this nursing education programme in Norway and elsewhere in Europe comprises of the clinical placement component [ 31 , 32 ]. As part of their professional responsibilities, the qualified and experienced registered nurses fulfilled the role of registered nurse mentors for students during their clinical placements. They focused on mentorship rather than actively teaching and developing the students’ competencies, indicating that mentoring by registered nurses was service-led rather than educationally driven. Although these registered nurse mentors possessed appropriate qualifications, they lacked formal academic educator competencies. Meanwhile, nurse educators bridged the gap between academic and placement knowledge. They possessed pedagogical knowledge and played a vital role in supporting, supervising and assessing student nurses. Nurse educators, who hail from the academic setting, bear the pivotal responsibility for the final decision of whether students pass or fail. They support, supervise and assist students and their registered nurse mentors during clinical placement and take care of the collaboration between these two stakeholders. The clinical experience for student nurses was set up through a collaborative effort between nurse educators from the university setting and registered nurse mentors in the clinical setting. In this collaboration, nurse educators were crucial to facilitating clinical learning experiences by securing optimal learning situations in the nursing homes in line with the educational learning outcomes. In these learning situations, the registered nurse mentors served as facilitators, mentors and role models. They also consistently provided valuable insight from their professional experiences, offered daily mentoring, and delivered feedback. This collaboration between the stakeholders aimed to help students in bridging the gap between the knowledge gained in the university setting and their clinical experiences in the nursing homes.

The digiQUALinPRAX resource being experienced in the study

The digiQUALinPRAX resource (Fig.  1 ) is a password-protected learning management system named Canvas (website), a technology that is used to plan, implement, and assess learning processes [ 33 ]. The overall educational aim of the digiQUALinPRAX resource was to enhance quality in nursing home placements by addressing students’ learning and the mentorship practices of educators and registered nurses (i.e. supervision and assessment). Nurse educators and registered nurse mentors, in turn, utilised this resource to enhance their teaching strategies, coordinate clinical placement activities, and ensure meaningful and enriching learning experiences for their students. The digiQUALinPRAX resource was designed to support the collaborative efforts of the stakeholders, fostering a dynamic and effective learning environment within the entire context of clinical placement education in nursing homes.

The digiQUALinPRAX resource consists of several core components as design features (i.e. interactive components, content components , and resource components ). The interactive components entailed features such as file sharing and messaging (through a dialogue forum), enabling stakeholders to interact with each other during the placement period. The dialogue forum provided a digital room where nurse educators and registered nurse mentors could provide written feedback on students’ assignments submitted through the digital educational resource.

Furthermore, the content components of the digiQUALinPRAX resource consisted of three content modules, including practical, educational, and contextual knowledge relevant for clinical placement in nursing homes. The three content modules were organized with different topics by the following titles: (1) Preparation to the clinical placement; (2) To study and supervise in clinical placementt; and (3) assessment of professional nursing competence. The first content module contained literature on pre-placement information, addressing the nursing home as a learning arena, role expectations, and schedule of the placement period. This content module further included a fixed time structure with predefined meetings. Additionally, an overview of the students’ theoretical educational content before placement and thus, their expected level of professional competence, was provided. The second content module contained literature on how to study, learn, and provide appropriate mentoring. This module provided examples of learning situations, as well as a description of students’ competence domains. These were tailored to accommodate the students’ learning objectives and mentoring activities. The use of reflection as a learning strategy was emphasized in this module. During the eight-week placement period, students had to write several reflection papers about various topics. The module further facilitated possibilities for nurse educators to provide written feedback on the reflection papers to stimulate and enhance students’ reflection skills. The third content module focused on assessment practices and provided information about formal and formative assessments. This was done by thoroughly describing the assessment forms through exemplifying how they could be used based on one specific patient situation. The formal assessment documents were all available directly in the digiQUALinPRAX resource.

The resource components of the digiQUALinPRAX resource consisted of practical, educational, and context-specific resources. These resources were illustrations, podcasts, video lectures, reflective activities, case-related activities, and resources to support nurse educators’ educational roles. Additional resources were study requirements, advice, and summaries of the core components.

figure 1

Core components of the digiQUALinPRAX resource

Study sample and recruitment

The target group for this study was nurse educators who were employees at one university in Norway, at which the digiQUALinPRAX was explored. The inclusion criterion was nurse educators having used the digiQUALinPRAX resource during an eight-week clinical placement period in nursing homes.

A purposive sampling strategy [ 34 ] was applied to recruit participants. After obtaining approval from the Vice-Dean of the Faculty of Health Sciences, potential nurse educators were sent recruitment e-mails. The e-mails contained general study information and a waiver of consent. Invitations were sent openly to nurse educators who had a supervisory responsibility to student nurses in nursing home placement. Six nurse educators consented to participate and received complete verbal information about the study. We considered these six nurse educators to be a representative sample [ 35 ] because they had used the digiQUALinPRAX resource during an eight-week placement period.

Research context

One week before the clinical placement period, the digiQUALinPRAX resource was precented and made accessible to the stakeholders (i.e. nurse educators, student nurses and registered nurse mentors) involved in the overall study. All stakeholders had access to the digiQUALinPRAX resource throughout the eight-week clinical placement period. As the target group in this study, the nurse educators were the only stakeholders possessing pedagogical knowledge and thus played a vital role in supporting, supervising, and assessing student nurses during their placements using the digiQUALinPRAX resource. Furthermore, they were responsible for collaborating with registered nurse mentors in their supervision of student nurses and in the use of the digiQUALinPRAX resource.

Data collection

Individual qualitative interviews with the six nurse educators were conducted for data collection. Data from individual interviews are valuable when the insight and understanding of participants’ perceptions, experiences, thoughts, and suggestions with respect to a given subject are of interest [ 29 ]. The qualitative nature of our research design, employing an in-depth exploration of the experiences of nurse educators, warranted a focus on detailed and context-specific insight rather than a large sample size [ 35 ]. The selected sample size was determined through a careful balance between power of information and the specific group of nurse educators with unique experience characteristics, which contribute to the depth of the analysis and results [ 35 ]. The nurse educators’ interviews were arranged in an academic nursing setting immediately after the eight-week clinical placement period in nursing homes for first year student nurses. Data were collected by the first author in April 2022.

A semi-structured interview guide was employed, addressing themes such as supervision and assessment possibilities, partnership, interaction and communication opportunities, and knowledge provided by the digital educational resource (see Supplementary File 1 ). Participants were offered opportunities to speak freely about their experiences, with follow-up questions where appropriate. Owing to COVID-19 restrictions, all interviews were conducted through a virtual platform via ZOOM using video and sound. This interview format encouraged two-way communication, allowing for conversations on relevant themes [ 29 ]. The interviews were audio recorded and lasted between 56 and 99 min. The six nurse educators provided rich information on their experienced usefulness of the pedagogical design features of the digiQUALinPRAX resource. The more information the participants held relevant to the actual study, the lower the number of participants needed [ 35 ].

Data analysis

All audio files were transcribed verbatim, resulting in text describing spoken words from the audio files underpinning the analysis, as recommended by Halcomb and Davidson [ 36 ]. After transcription of the audio files, text data were analysed using systematic text condensation in line with Malterud [ 37 ] (e.g. an explorative and descriptive method for thematic analysis that addresses the characteristics and essence of the subject being studied). NVivo software [ 38 ] version 12 was used for data analysis.

Data analysis was inductive; the text was re-read for a general overview and to familiarise the researchers with the content. Preliminary themes were captured in the first phase of the analysis. In the second phase, meaning units were identified and organised in relation to each of the themes captured in phase one. This data extraction approach entailed the decontextualization of the text: to be separated into parts or segments and removed from the belonging context [ 37 ]. Each meaning unit was coded and sorted into code groups. These were created in relation to each theme and provided a platform for the next phase of the analysis, in which a deeper meaning of experience was sought. In the third phase, the code groups were divided into sub-groups; the meaning units in the sub-groups were rewritten into condensates [ 37 ]. I–form was chosen to optimally represent the participants’ views, and their own words were used to maintain the original terminology. After completing the condensates, illustrative quotations (translated into English) were selected. Adjustments were made to provide a clearer understanding of the statements. In the fourth phase, the decontextualised text was recontextualised and synthesised; that is, parts were put into a new context while being true to the text from which the data were extracted. The condensed text from each sub-group within the code groups ‘went beyond’ the condensates, and new interpretive descriptions about the subject being studied were generated, to be presented in a third-person format [ 37 ]. Throughout the analysis, the first and last authors discussed the codes, sub-categories, and categories until reaching consensus. The recontextualisation resulted in two categories and five sub-categories.

To ensure the trustworthiness of this qualitative study, credibility, dependability, transferability, and confirmability were considered

[ 39 ]. Credibility was ensured in this study using an interview guide to establish consistency in the data collection process. Furthermore, video recordings (ZOOM) and transcription of the interviews verbatim helped ensure an accurate and complete representation of the nurse educators’ responses. Dependability was ensured by describing data collection and analysis in detail. NVivo was used to organise and visualise the data. Moreover, nurse educators’ arguments were quoted to show the links between the findings and data. To enhance the transferability, detailed descriptions of the research process were provided. Investigator triangulation was applied, where the first and last authors engaged in discussions and revisited the transcripts to ensure that the interpretations were supported by the data transcripts. The first and last authors held regular meetings to discuss the data analysis and ensure confirmability. Nurse educators were selected to provide in-depth data. Few participants were needed; information power was attained owing to the sample specificity and quality of dialogue [ 35 ].

Ethical considerations

This study was approved by the Norwegian Centre for Research Data (2018/61,309 and 489,776) and the university included prior to data collection. According to national regulations, approval from a medical ethical committee (Regional Committees for Medical and Health Research Ethics) to collect this type of data was not necessary. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki [ 40 ]. The consolidated criteria for reporting qualitative research (COREQ) guideline was used to report the study. All participants received written and verbal information about the study, including the voluntary nature of participation and the right to withdraw from the study. All participants provided written informed consent, while non-participants refused to take part in the study. To ensure confidentiality, participants’ characteristics such as age, sex, educational background, and years of experience in placement education supervision were not provided. All data were anonymised and securely stored to ensure confidentiality and protect private information.

The qualitative analysis of nurse educators’ experiences in relation to the pedagogical design features of the developed digiQUALinPRAX resource resulted in perceptions and reflections of the following key categories: (1) supporting supervision and assessment of student nurses and (2) supporting interaction and partnership between stakeholders (Table  1 ).

Supporting supervision and assessment of student nurses

Nurse educators experienced that the pedagogical design features of the digiQUALinPRAX resource allowed for supporting supervision and assessment in terms of giving students feedback on their written assignments, encouraging their reflections and facilitating summative assessments of their study progression.

Offering possibilities to provide students feedback on their written assignments (directly in the dialogue forum)

Nurse educators positively experienced the interactive component of the digiQUALinPRAX resource as providing possibilities for giving written feedback on students’ written submissions in the dialogue forum, both from nurse educators and registered nurse mentors. Moreover, nurse educators experienced the digiQUALinPRAX resource to be useful as it forced them to provide feedback on all the students’ written assignments. However, they found it challenging to provide written feedback via the dialogue forum because it was not possible to simultaneously review students’ submissions while providing written feedback through the digiQUALinPRAX resource.

I had to go in and out of the dialogue forum when written feedback was provided on students’ submissions to read the text of the submissions. (Informant 4)

Offering possibilities to encourage students’ reflections

Nurse educators experienced the digiQUALinPRAX resource to be useful in terms of guiding specific topics for the reflection papers that were written and submitted by student nurses during placement, stating that it contributed to a more common focus on student learning during placement. They also positively experienced that the digiQUALinPRAX resource ensured that the topics of the reflection papers were not arbitrary and dependent on the individual nurse educators’ personal recommendations and preferences, which helped them provide more consistent supervision with a focus on student learning.

Learning focus became more common for student nurses because the digital educational resource guided them in terms of the topics that they should write about. (Informant 5)

Furthermore, nurse educators experienced the digiQUALinPRAX resource-led reflection papers written by students as a useful source of information. Specifically, these papers allowed nurse educators to gain valuable insights into each student’s learning and knowledge levels, enabling them to identify areas requiring further attention for learning and development. They experienced such papers as providing them with a clear understanding of the aspects that they should focus on and providing feedback to students. This approach enabled them to help correct misunderstandings and fill gaps in students’ academic and professional knowledge.

The use of the digiQUALinPRAX resource was experienced by nurse educators to help both inexperienced and experienced nurse educators when supervising students in nursing home placements and guiding reflection group meetings. Inexperienced nurse educators were helped to understand the concept and purpose of reflection and how to encourage students to engage in reflective processes. They further faced experienced educators as helping them obtain a better structure for the reflection group meeting, focusing on the reflection group towards the real education levels and learning outcomes. Nurse educators experienced that the use of the digiQUALinPRAX resource in reflection group meetings resulted in a superior focus on students’ learning processes. Moreover, supervision became more student- rather than teacher-centred.

I became more like a facilitator than a nurse educator in the reflection group meetings because the digital educational resource-led questions helped me encourage the students to reflect amongst themselves and with me as an educator. (Informant 1)

Nurse educators experienced the digiQUALinPRAX resource-led pedagogical materials as useful in influencing students’ engagement and verbal activity during reflection group meetings.

The case is great to work on together with the students. Additionally, the students enjoyed working on the case, they became actively engaged. (Informant 4)

Nurse educators experienced that digiQUALinPRAX resource-led pedagogical materials, such as cases, care plans, and reflection questions, served as a foundation for the reflection group meetings and consequently, facilitated students’ development of professional understanding and competence about the nursing profession.

Facilitating provision of summative assessments of students’ study progression

Several nurse educators experienced that using digiQUALinPRAX resource-led single patient situations as the basis for providing summative student assessments restricted the ability to comprehensively assess student progression on all items of the assessment form.

Sufficient data were unavailable to provide summative assessments of student progression using only one patient situation. (Informant 2)

Some nurse educators included multiple patient situations as the basis for providing summative student assessments, even though this was not guided by the digiQUALinPRAX resource; they experienced this to be beneficial for ensuring comprehensive coverage of all items on the assessment form. The nurse educators felt that this allowed students to demonstrate their study progress and identify areas of improvement.

It was unproblematic that the varied assessment items were written based on different patient situations because they provided more information about the student’s progression. (Informant 1)
Students completed the assessment based on several patient situations to show their knowledge well enough. (Informant 6)

Nurse educators experienced their role in summative assessment meetings as more constructive when registered nurse mentors completed the digiQUALinPRAX resource-led assessment form prior to the summative assessment meetings. This was because they adopted a cautious approach during assessment meetings as the registered nurse mentors’ verbal participation increased when they filled in their digiQUALinPRAX resource-led student evaluation form prior to the assessment. Specifically, nurse educators regarded it as a positive experience when registered nurse mentors provided clear verbal feedback on areas where students required further progress during the placement study.

Registered nurse mentors’ threshold for being verbally engaged during summative assessment situations was lowered because they had completed the digital-educational resource-led assessment form prior to the assessment meetings (Informant 1) .
Registered nurse mentors who had prepared themselves by writing in the digital educational resource-led assessment form were more verbally engaged during the summative assessment meetings. (Informant 6)

The registered nurse mentors’ clear and precise communication of students’ areas that required improvement during the placement was experienced positively by the nurse educators, as it provided them with a clear focus on what to prioritise when further supervising the students’ progress.

When the registered nurse mentor completed the digital-educational resource-led assessment form and was verbally engaged during the summative assessment meeting, the student’s next steps became clear. (Informant 2)

Supporting interaction and partnership between stakeholders

Nurse educators experienced that the interactive digiQUALinPRAX resource design contributed to increased support for interactions and establishing partnerships between stakeholders through stimulating communication and cooperation between stakeholders.

Simplifying and supporting interactions and cooperation between the stakeholders

Nurse educators experienced that the digiQUALinPRAX resource-led timeline enabled them to schedule equal in-person supervision group meetings with students during their clinical placement. Further, they experienced interactions and cooperation with students as important for encouraging students to engage in appropriate and meaningful learning processes and as a feature of conducting accurate student assessments during placements.

I established closer contact with the students because I used the digital education resource. (Informant 6)

Additionally, nurse educators experienced their cooperation with registered nurse mentors to have improved because of the use of the digiQUALinPRAX resource; that is, the registered nurse mentors contacted nurse educators more during clinical placement compared with before. As part of the appropriate student supervision, nurse educators emphasised the importance of a proper relationship between the clinical placement setting and various registered nurse mentors.

The threshold for the registered nurse mentors to contact me as an educator was lowered owing to the use of the digital educational resource. (Informant 1)

Simplifying and stimulating communication using the dialogue forum

Nurse educators experienced the dialogue forum usage to be unclear, and gave feedback on how they could appropriately use the dialogue forum (i.e. the digiQUALinPRAX resource-led interactive component that facilitates communication between the stakeholders during the placement).

Clarifications about the use of the dialogue forum should have been made because we were not used to making discussions in this forum. (Informant 1)

However, the nurse educators considered that the dialogue forum should only provide possibilities for communication between the varied stakeholders included in the supervision collaboration: the students, registered nurse mentors, and nurse educators. Nurse educators experienced this as a necessity for a dialogue forum that also fosters transparency and open communication between the nurse educator and their student group, such as an information channel providing possibilities for a nurse educator to disseminate the same information to all students in the student group simultaneously.

It is out of question sending information to students individually that can be disseminated to all students. (Informant 5)

Nurse educators experienced it that it was necessary for a dialogue forum to provide possibilities for confidentiality (e.g. as an alternative to emails for stakeholder communication). Moreover, confidentiality was not ensured in cases where students might not pass their placement. Students’ exclusion from the forum was requested when discussions solely between the educator and registered nurse mentor might be necessary.

I cannot raise challenging student situations in a dialogue forum if the student has access to the digital room. (Informant 3)

The current study aimed to explore and describe how nurse educators experienced the usefulness of the pedagogical design features of the digiQUALinPRAX resource from their perspective. Nurse educators’ positive experiences regarding the digital educational resource highlighted the pedagogical design features as unique features, improving their supervision and assessment of student nurses during clinical placement education in nursing homes. These findings align with those of previous studies suggesting that pedagogical design is essential for creating digital educational resources [ 26 ]. This is an important finding, as pedagogical design features are often overlooked in the technologies designed to enhance and support clinical placement education in Bachelor’s nursing programmes [ 26 , 41 ].

Nurse educators experienced the interactive communication features of the digiQUALinPRAX resource as a valued component, as it enhanced their ability to provide written feedback on students’ submissions for their learning processes. This finding is also important, as earlier research [ 42 , 43 ] has revealed that many students received insufficient written feedback on their submissions from nurse educators during clinical placement education. This inappropriate feedback may have a negative influence on students’ learning experiences, whereas it might hinder them in their ability to identify areas in which they need to improve and further study to close their gap in knowledge [ 43 ]. Hence, feedback plays a crucial role in supporting students in understanding their strengths and weaknesses, thereby helping them achieve their learning outcomes [ 44 , 45 , 46 ].

Providing written feedback on student submissions was also important for nurse educators in our study. File sharing, as an interactive part of the digiQUALinPRAX resource, enabled the nurse educators to gain insights into the students’ knowledge levels and provide feedback based on their individual learning needs. This aligns with the sociocultural learning perspective, which underscores Vygotsky’s [ 46 ] theory of learning and development. According to this theory, interactions with more proficient persons can help the learner advance to the next level of knowledge and understanding within their zone of proximal development.

Our findings also revealed that nurse educators experienced that scheduled digiQUALinPRAX resource-led submissions contributed to students receiving frequent feedback. This finding is in line with the results of Bosse et al. [ 47 ], who emphasised the benefits of receiving frequent feedback, as it led to better learning outcomes. Moreover, this illustrates that considering integrating pedagogical design features when developing digital educational resources is valuable in stimulating nurse educators to facilitate students’ learning processes.

Nurse educators noted that pedagogical design features of the digiQUALinPRAX resource helped them encourage students to actively engage in reflective thinking, both verbally and in writing. Reflective thinking involves critically analysing experiences, considering one’s thoughts and emotions and examining the broader context [ 48 ]. Improved learning through reflective-thinking processes among students has also been considered in prior research, showing that it can deepen the comprehension of learning objectives and increase the awareness of decision-making in clinical reasoning [ 49 , 50 ]. This indicates the importance of possessing reflective thinking skills, not only in improving self-directed learning but also in delivering high-quality patient care [ 48 , 51 ].

The study findings indicated that pedagogical design features of the digiQUALinPRAX resource facilitated a shift in the nurse educators’ role in reflection group meetings. The shift entailed moving from being nurse educators who often communicated their knowledge to assuming the role of facilitators who guided discussions and encouraged students’ reflections and critical thinking. This pedagogical approach prioritises a student-centred learning model, enabling student nurses to construct their understanding actively rather than passively receiving the presented information [ 49 , 50 ]. This finding is important because nurse educators often fail to involve students in reflective-thinking activities during their educational process, resulting in a lack of student participation and difficulties in comprehending learning objectives [ 6 , 48 , 52 , 53 , 54 , 55 ]. Regarding this issue, Dalsmo et al. [ 52 ] revealed that nurse educators were often ‘invisible’ in students’ learning processes during nursing home placement, hindering students’ ability to participate fully and comprehend the learning objectives.

Nurse educators positively experienced that pedagogical design features of the digiQUALinPRAX resource encouraged registered nurse mentors to provide a written assessment concerning both the strengths and weaknesses of student progression prior to summative assessment meetings, resulting in registered nurse mentors becoming more verbal during the meetings. Several studies have reported that nurse educators experience challenges in assessment meetings because of registered nurse mentors’ silence [ 42 , 52 , 56 ]. When nurse educators in our study experienced that registered nurse mentors wrote and verbalised what was expected from the students to work on during the remaining placement study, they were given opportunities to gear their student supervision towards the learning needs to focus on. From this perspective, nurse educators experienced that pedagogical design features of the digiQUALinPRAX resource facilitated both themselves and the registered nurse mentor to develop a common understanding regarding students’ learning needs. Previous research has revealed that educators and registered nurse mentors often have different expectations regarding students’ learning needs during placement studies [ 56 , 57 ]; thus, creating a common understanding among the stakeholders is crucial for effective student supervision.

Having a clear structure in the form of a timeline was a distinct pedagogical design feature of the digiQUALinPRAXresource that enhanced nurse educators’ student supervision abilities. They reported that the timeline specifying the number of physical meetings to be held during the placement period (and when they occurred) contributed to nurse educators being able to organise physical meeting frequency more equally. This is a valuable pedagogical design feature of the digiQUALinPRAX resource because dissatisfaction among students with their nurse educators’ physical presence in follow-ups during placement studies has been reported [ 3 , 6 ]. Further, the nurse educators experienced the timeline-defined specific topics for the reflection papers positively, ensuring that the topics did not become dependent on individual nurse educators’ preferences. In Ravik et al. [ 42 ], nurse educators requested greater consensus among themselves to enhance student supervision. Differences among nurse educators might be perceived as unjust by students and could account for some students learning more than others during placement studies because they receive more personalised attention from their nurse educators [ 58 ]. Therefore, including timeline-defined physical meetings for nurse educators and defined topics of the reflection papers might help address this issue. Both Cant et al. [ 3 ] and Laugaland et al. [ 8 ] reported that inconsistency between educators hinders improvements in students’ learning. Moreover, it was deemed essential for nurse educators to be physically present during clinical placement to ensure that they maintained suitable communication with registered nurse mentors. These findings are consistent with those of previous studies, suggesting that appropriate relationships and communication between stakeholders are critical for creating a supportive and collaborative learning environment for students [ 3 ].

Nurse educators positively experienced the inclusion of interactive design features in the form of a dialogue forum. This forum played a vital role in facilitating interactions between students and the stakeholders involved in overseeing and supervising students during their nursing home placement. Previous research supports the notion that this interactive design feature, integrated into digital educational resources, is essential for effectively implementing and utilising technology to enhance student supervision [ 20 , 42 , 59 ]. Notably, the presence of such dialogue forums, which enables interaction among stakeholders, has been reported as an indicator of satisfaction with digital educational resources [ 20 ]. This underscores the importance of fostering a sense of belonging within a learning community, which has been recognised as vital to student nurses’ placement learning experiences [ 60 ]. Even though the nurse educators highlighted the importance of a dialogue forum contributing to openness between all stakeholders during student supervision, they pointed out that the dialogue forum should be available for the nurse educator and registered nurse mentor only, allowing for confidential dialogues in challenging situations. Therefore, the interactive dialogue forum can create an atmosphere where nurse educators and registered nurse mentors can share concerns, exchange perspectives, and collaboratively develop strategies to address the challenges faced by students [ 42 ]. This is in line with previous research suggesting that open and confidential communication among stakeholders contributes to finding common ground and fostering productive resolutions [ 57 ].

Limitations and future research directions

Some limitations should be considered when interpreting the results of this study. Individual interviews were conducted by the first author, who was also involved in the design and development of the digital educational resource, digiQUALinPRAX. However, the first author was unknown to the participants, and lived and worked in another part of the country. Additionally, the participants were encouraged to frankly share their experiences and opinions regarding the use of digital educational resources. Despite the small sample size, the rich information that they provided allowed for the in-depth feedback and experiences we had aimed for in this study. It is, however, important to acknowledge that while the results may provide valuable insight into the experiences of the nurse educators, transferability to broader populations may be limited. Qualitative research is needed to explore and deepen these findings from the perspectives of student nurses and registered nurse mentors for the improvement of digiQUALinPRAX. Moreover, quantitative research is essential to providing knowledge about the effectiveness of digiQUALinPRAX in measuring and assessing student learning. Additionally, to broaden the applicability of the current study, it is recommended to explore the results across diverse healthcare educational settings, such as hospital settings for second- or third-year students. It is also suggested to explore revisions to the digital educational resource that would enable its adaptation to other internships within nursing education. This expanded exploration may contribute to the transferability of the results and enhance the broader relevance of the study’s implications.

Conclusions

The nurse educators gave in-depth information on how they experienced the usefulness of the pedagogical design features of the digiQUALinPRAX resource, developed to support their role in nursing home placements. The digiQUALinPRAX resource was experienced to display several positive pedagogical design features for enhancing the supervision and assessment of student nurses, while also promoting possibilities for interactions and partnerships among stakeholders. Notably, its inclusion of a timeframe was experienced as beneficial for ensuring greater consistency among nurse educators in student supervision. Additionally, its resource design facilitated student feedback, enabled nurse educators to better understand students’ current knowledge levels as well as their need for further supervision and learning. Furthermore, it was experienced as positive that pedagogical design features of the digiQUALinPRAX encouraged nurse educators to engage students in the reflective-thinking processes. Moreover, it was positively experienced that pedagogical design features of the digiQUALinPRAX contributed to registered nurse mentors becoming more verbal in assessment meetings, which also positively contributed to nurse educators’ further supervision of students during nursing home placement.

Data availability

To access the data in this study, please contact the corresponding author.

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Acknowledgements

We would like to thank all the participants who made the study possible. Thanks to Ingrid Espegren Dalsmo, UiA and NETTOPP-UIS, Department for Development of Digital Learning Tools, for their valuable participation and contribution in design and development of Fig.  1 .

This study was supported by the Research Council of Norway (RCN) (Grant number 273558). The funder had no role in the design of the project, data collection, analysis, interpretation of data or writing and publication of the manuscript.

Open access funding provided by University Of South-Eastern Norway

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Kristin Laugaland, Kristin Akerjordet & Ingunn Aase

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Contributions

All authors conceptualised the study and developed the interview guides. MR conducted the data collection and designed and developed Fig.  1 . MR and MTG conducted the data analysis and interpretation, as well as drafted and revised the manuscript. KL, KA, and IA provided critical revisions for important intellectual content. All authors reviewed and approved the manuscript.

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Correspondence to Monika Ravik .

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Ethics approval and consent to participate.

This study was approved by the Norwegian Centre for Research Data (2018/61309 and 489776) and the university included prior to data collection. According to national regulations, approval from a medical ethical committee (Regional Committees for Medical and Health Research Ethics) to collect this type of data was not necessary. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki [ 40 ]. The consolidated criteria for reporting qualitative research (COREQ) guideline was used to report the study. All participants received written and oral information about the study, including voluntary nature of participation, and the right to reject or withdraw from the study. All participants provided written informed consent. To ensure confidentiality, participants’ characteristics such as age, sex, educational background, and years of experience in placement education supervision were not provided. All data were anonymised and securely stored to ensure confidentiality and protect private information.

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Ravik, M., Laugaland, K., Akerjordet, K. et al. Usefulness of pedagogical design features of a digital educational resource into nursing home placement: a qualitative study of nurse educators’ experiences. BMC Nurs 23 , 135 (2024). https://doi.org/10.1186/s12912-024-01776-5

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Fear of depression recurrence among individuals with remitted depression: a qualitative interview study

  • Stephanie T. Gumuchian 1 ,
  • Ariel Boyle 1 ,
  • Lori H. Hazel 1 &
  • Mark A. Ellenbogen 1  

BMC Psychiatry volume  24 , Article number:  152 ( 2024 ) Cite this article

Metrics details

Major Depressive Disorder (MDD) is a prevalent psychiatric condition and the largest contributor to disability worldwide. MDD is highly recurrent, yet little is known about the mechanisms that occur following a Major Depressive Episode (MDE) and underlie recurrence. We explored the concept of fear of depression recurrence (FoDR) and its impact on daily functioning among individuals in remission from MDD.

30 participants (83% female; 37% White; M age = 27.7, SD = 8.96) underwent semi-structured qualitative interviews. The interviews explored participants’ experiences of FoDR including the frequency, severity, content, triggers, and impact of fears and associated coping strategies. We used content analysis to analyze the transcriptions.

Most participants (73%) reported having FoDR, with varying frequency, severity, and duration of fears. The triggers and content of participants’ fears often mirrored the symptoms (e.g., low mood, anhedonia) and consequences (e.g., job loss, social withdrawal) endured during past MDEs. Some participants reported a minimal impact of FoDR on daily functioning, whereas others reported a positive (e.g., personal growth) or negative (e.g., increased anxiety) influence.

Limitations

Our sample size did not allow for explorations of differences in FoDR across unique MDD subtypes or sociocultural factors.

Conclusions

The concept of FoDR may present a window into understanding the unique cognitive and behavioural changes that occur following MDD remission and underlie depression recurrence. Future research should aim to identify underlying individual differences and characteristics of the disorder that may influence the presence and impact of FoDR. Finally, a FoDR measure should be developed so that associations between FoDR and recurrence risk, depressive symptoms, and other indices of functioning can be determined.

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Major Depressive Disorder (MDD) is a debilitating psychiatric condition and the largest contributor to disability worldwide [ 1 ]. It is considered to have the highest lifetime prevalence among psychiatric conditions, affecting over 300 million people [ 2 ]. MDD is considered a chronic condition as approximately 50–85% of individuals who have had at least one Major Depressive Episode (MDE) experience a second, with this percentage increasing for individuals with multiple past MDEs [ 3 , 4 , 5 ]. Despite mounting evidence of MDD’s high recurrence, little is known about the predictors and mechanisms underlying recurrence.

There are several limitations to research in MDD that challenge our ability to discern the conditions that lead to subsequent MDEs. These concerns include overreliance on cross-sectional methodologies, a lack of consensus on what constitutes recurrence, and grouping all individuals with MDD together instead of differentiating subgroups using key characteristics of the disorder (e.g., single verse recurrent episodes) [ 3 , 6 , 7 , 8 ]. The existing literature focuses on identifying individual factors (e.g., genetic vulnerability) and evaluating the role of treatment in predicting future MDEs [ 3 , 9 ]. Research on recurrence risk factors have identified that residual symptoms, anxiety disorders, childhood maltreatment, and previous MDEs are some of the strongest prognostic factors in recurrent depression [ 10 ]. A review exploring prospective biomarkers (e.g., hormones, oxidative stress) in MDD recurrence found that cortisol significantly increased odds for MDD onset and relapse [ 6 ]. These indicators, however, do not provide insight into the cognitive and behavioral changes that occur following MDE remission and underlie future recurrence [ 7 ].

Individuals may behave differently following an MDE out of fear of future relapse, such as reducing risk-taking and being hypervigilant to symptom changes [ 11 ]. Fear of illness recurrence (FIR) is defined as concern, fear, or worry that one’s illness will eventually return [ 12 ]. FIR has been widely studied in cancer and other chronic health conditions and is associated with greater avoidance of illness reminders (e.g., medical appointments), disregarding symptom changes, and social withdrawal [ 13 , 14 , 15 , 16 ]. FIR in cancer is associated with lower mood, greater depression and anxiety, reduced quality of life, and lower engagement in health behaviours [ 17 , 18 , 19 , 20 ].

Research on FIR in psychiatric conditions is scarce. Studies of psychotic disorders have reported that FIR significantly predicted future relapse and was associated with increased positive psychotic symptoms, depression, anxiety, and greater use of maladaptive coping strategies (e.g., reassurance seeking) [ 21 , 22 ]. In MDD, some individuals have endorsed FIR following the discontinuation of antidepressants [ 23 , 24 , 25 ]. Others have reported that the fear surrounding experiencing another MDE influenced participant’s decision making and willingness to take risks [ 11 ]. To our knowledge, no studies have focused exclusively on understanding fear of depression recurrence (FoDR), defined in this study as having concerns, fears, or worries that one’s symptoms of depression will return or worsen at a future time.

Although an exploratory study, we aimed to investigate whether remitted depressed individuals experience FoDR, and if so, to explore the influence of these fears on daily functioning including coping, engagement in specific behaviours (e.g., avoidance, help-seeking), changes to cognitions and emotional states, and social patterns (e.g., withdrawal, seeking professional help). Exploring the concept of FoDR and its potential relationship to relapse, depression symptoms, and other indices of functioning may provide a better understanding of the unique cognitive and behavioural changes that occur following remission from an MDE and underlie depression recurrence. If found to influence important indicators of recurrence in MDD, FoDR may represent a novel phenomenon that can be targeted by future prevention and intervention efforts in MDD.

The present study

This qualitative inquiry aimed to gain a better understanding of individuals’ experiences of FoDR. We used a social constructivist framework to guide this phenomenological study, given the important influence of culture, past experiences, social interaction, and context on an individuals’ beliefs about, and experiences with, MDD [ 26 , 27 , 28 ]. We conducted semi-structured interviews to: [ 1 ] identify whether remitted depressed individuals experience FoDR and evaluate the severity, frequency, triggers, and content of these fears; [ 2 ] explore how people respond to and cope with these fears; and [ 3 ] understand the impact of FoDR on daily functioning.

This study was approved by the Human Research Ethics Committee at Concordia University in Montréal, Québec, Canada (REB# 30013399) and pre-registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/GQR2S ). The pre-planned methodology was designed and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist (COREQ) [ 29 ] and the Standards for Reporting Qualitative Research (SRQR) [ 30 ].

Participants and recruitment

English-speaking adults above the age of 18 years and in remission from MDD were recruited. First, participants who had previously completed a study in our lab were recruited via email. Second, we recruited participants from Québec institutions and mental health organizations using recruitment advertisements posted on social media platforms (e.g., Twitter, Facebook). As described in the Diagnostic and Statistical Manual of Mental Disorders (DSM, 5th Edition), participants were considered remitted from MDD if they reported a history of MDD and had been symptom-free for a consecutive period of at least two months [ 31 ]. Exclusion criteria included having [ 1 ] a major chronic medical illness highly associated with one’s past MDE; [ 2 ] a current and/or lifetime history of bipolar disorder I or II, a psychotic disorder (except if part of MDD), or a pervasive developmental disorder; and [ 3 ] a past or current comorbid Axis-1 disorder deemed to be one’s primary mental health diagnosis other than MDD.

Materials and measures

Mini International Neuropsychiatric Interview Version 7.0.2 (MINI) [ 32 , 33 ]. The MINI is a structured diagnostic interview used to assess DSM-5 mental disorders. It was used to assess for MDD, in remission, and to rule out the presence of any comorbid mental disorders. Psychometric evaluations of the MINI report satisfactory interrater reliability and concurrent validity with the Composite International Diagnostic Interview [ 34 ].

Patient Health Questionnaire– 8 (PHQ-8) [ 35 ]. The PHQ-8 is a validated self-report scale used as a diagnostic and severity measure for depression. Participants report how often they were bothered by symptoms of depression over the last two weeks, with higher total scores reflecting greater depressive symptoms. Participants reporting scores greater than 10 during our eligibility screening were excluded. The PHQ-9, which is psychometrically comparable to the PHQ-8, has excellent internal and test-retest reliability and adequate criterion and construct validity [ 36 ].

Symptom Checklist 90– Revised (SCL-90-R) [ 37 , 38 ]. The SCL-90-R self-report scale evaluates psychological distress and symptoms of psychopathology across nine domains: Somatization, Obsessive-Compulsivity, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism. The SCL-90-R also provides a Global Severity Index (GSI) which measures overall psychological distress. Participants indicated how much they were bothered by various symptoms over the past week. Higher scores reflect greater levels of pathological distress. The SCL-90-R has good internal reliability and high concurrent validity [ 39 ].

World Health Organization Quality of Life Instrument-BREF (WHOQOL-BREF) [ 40 , 41 ]. The WHOQOL-BREF self-report scale measures quality of life (QoL) across four domains: physical health, psychological health, social relationships, and environment. Higher scores represent higher QoL. These domains have adequate internal consistency and test re-test reliability [ 41 ].

Beck Depression Inventory (BDI-II) [ 42 ]. The BDI-II is a 21-item self-report questionnaire evaluating current depression symptoms. Higher scores indicate greater depressive symptoms. The BDI-II has excellent internal consistency and test re-test reliability [ 43 ].

Semi-structured interviews

Participants underwent a 60–90-minute semi-structured interview via Zoom [ 44 ] between October 2020 and January 2021. The first two authors of this paper (STG and AB), senior graduate students in clinical psychology, conducted and analyzed the interviews. The interviews were audio- and video-recorded and transcribed verbatim.

Our interview guide (see Additional File 1 ) was developed in our laboratory and inspired by existing FIR questionnaires and qualitative interview guides [ 45 , 46 ]. The first section of the interview was comprised of open-ended questions about participants’ history of, and experiences with, MDD, FoDR, and the COVID-19 pandemic (data not reported). The FoDR questions explored the frequency, severity, content, triggers, and impact of participants’ fears and inquired about how participants respond to and cope with FoDR. Participants were also asked to generate a list of structured questionnaire items that will be used to develop a FoDR questionnaire. Our interview guide was reviewed iteratively by our research team until consensus on the items was reached.

Interested participants were invited via email to take part in an initial phone screening to obtain oral consent and confirm eligibility. If eligible, participants were provided with additional information about the study and invited to complete an online survey containing demographic questions and additional questionnaires on SurveyMonkey [ 47 ]. They then underwent the MINI and the qualitative interview. Recruitment ceased once data saturation had been achieved [ 48 ]. Participants were compensated $40.

Data analysis

We used a content analysis approach to analyze the transcribed interview data, whereby repeated ideas and key concepts are labelled, coded, and categorized inductively from the data and integrated with existing literature [ 49 , 50 ]. Content analysis enables the systematic and objective description and quantification of novel phenomena [ 51 ]. This approach allowed us to openly explore participants’ experiences with FoDR, while dually enriching our broader knowledge of FIR.

The first two authors (STG and AB) began by reading the transcriptions to fully immerse themselves in the data, before independently reviewing the first ten interviews word-by-word and assigning codes to every text fragment (i.e., units of meaning). The authors then reviewed these codes until consensus on labels was achieved and a preliminary coding scheme was developed. Then, both authors used this scheme to independently code the remaining twenty interviews. The first author (STG) then compared the two sets of codes obtained from coding the final twenty interviews and consensus was achieved through discussion with author AB until a final coding manual was established. Once all the interviews were coded, the investigators grouped codes capturing similar ideas into categories and subcategories. Quotations capturing thoughts that meaningfully expressed the core idea of each category were extracted and reported in-text and in Additional File 2 . Coding was supported by the qualitative research software ATLAS.ti (Version 22.1.0) [ 52 ] and analysis of the demographic characteristics and psychosocial measures was conducted using the Statistical Package for Social Sciences (SPSS; Version 28) [ 53 ].

Participant characteristics

Phone screenings were conducted with 51 participants, of which 36 were eligible to complete the questionnaires, MINI, and interview. Three participants did not complete subsequent parts of the study and three were excluded due to reporting current depressive symptoms. Thirty individuals (83% female; 37% White; Mean Age = 27.7) with remitted MDD completed the full study. Sociodemographic characteristics are presented in Table  1 , mental health history in Table  2 , and scores on the psychosocial measures in Table  3 .

Participants’ subjective reporting of the number of lifetime MDEs varied ( n  = 27; M = 7.33; SD = 13.18; Range = 1–60), with most experiencing two or more MDEs ( n  = 17; 63%). Almost all participants reported that they currently have no depression symptoms or that they have some symptoms that do not bother them or interfere with their life ( n  = 26; 96%). Due to an experimenter error, three participants were not prompted on SurveyMonkey to self-report specific MDD characteristics (see Table  2 ). Within the qualitative interviews, some participants ( n  = 24) indicated that their past MDEs ranged in duration (1 month– 20 years) and all participants reported being in remission for at least three months (3 months– 14 years).

Qualitative findings

We report here the most frequently mentioned codes. Reported “ n ” values refer to the number of times a code was mentioned by participants across the full interview. Reported percentages (%) refer to the percentage of our sample who reported the code at least once. Additional File 2 contains a complete list of all codes, categories, and subcategories and Fig.  1 contains a list of all FODR categories and subcategories.

figure 1

All FoDR categories, subcategories, and codes

Participants’ experiences with depression

Triggers of past MDEs. Participants reported interpersonal triggers of past MDEs, including social conflict ( n  = 32, 50%), feeling alone, isolated, and unsupported ( n  = 17, 47%), and relationship loss (e.g., grief, breakup; n  = 11, 27%). Other MDE triggers included uncertainty about one’s future ( n  = 26, 47%), academic ( n  = 24, 53%) and occupational ( n  = 18, 30%) stressors, and transitions ( n  = 16, 30%).

Symptoms and consequences of past MDEs. All participants reported common MDD symptoms including depressed mood and negative cognitions ( n  = 61, 97%), sleep difficulties ( n  = 34, 80%), anhedonia ( n  = 36, 73%), feelings of worthlessness, guilt, and self-criticism ( n  = 26, 63%), weight and appetite changes ( n  = 19, 43%), and suicidal ideation and/or non-suicidal self-injury ( n  = 19, 33%). Reported consequences of past MDEs included difficulties functioning socially ( n  = 29, 63%), taking care of oneself ( n  = 15, 30%), and academic ( n  = 18, 37%) and occupational challenges ( n  = 7, 23%). Participant FD26 described the consequences of their MDE: “ I had to drop out of school, I had to stop working. I could barely take care of myself.”.

Coping strategies used to cope with past MDEs. The most mentioned coping strategy to manage depressive symptoms was to seek help from a mental health professional ( n  = 37, 67%). Additional coping strategies included social support ( n  = 21, 40%), cognitive strategies ( n  = 16, 27%), medication ( n  = 15, 37%), and behavioural strategies ( n  = 16, 37%).

Experience of being in remission from MDD. When asked about remission, participants reported improvements to their mood ( n  = 22, 63%) and ability to take care of themselves ( n  = 8, 23%). For some, the experience of living through an MDE led to greater self-efficacy ( n  = 20, 50%), enhanced identity development and personal growth ( n  = 15, 33%), and a positive shift in one’s worldview (e.g., open-mindedness; n  = 13, 30%). Some participants described experiencing distinct changes post-MDE including difficulty differentiating “normal” emotions (e.g., sadness) from clinical depression ( n  = 6, 20%) and continuous pressure to manage one’s mental health ( n  = 6, 13%).

Participants’ experiences with FoDR

Presence, frequency, and severity of fears. Twenty-two (73%) participants reported experiencing FoDR and eight (27%) indicated that they either do not experience FoDR or that their FoDR does not concern them. We explored differences in the presence of FoDR among the 27 participants in our sample who reported having either one past MDE (37%) or a history of two or more MDEs (63%). Among the 10 participants who reported having one past MDE, seven reported FoDR and three did not. For the 17 participants reporting a history of having two or more MDEs, 13 endorsed FoDR whereas four did not.

The frequency and severity of these fears varied. Some indicated that they have FoDR on a weekly ( n  = 12, 23%) or monthly ( n  = 10, 30%) basis, with these fears typically lasting a few minutes ( n  = 13, 43%) or hours ( n  = 7, 23%). Others reported that their fears remained persistent for days ( n  = 5, 17%). When asked to provide fear and distress ratings on a ten-point scale (1: “Not at all distressing/scared”, 10: “Extremely distressing/scared”), most participants reported distress ratings of five ( n  = 10) or six ( n  = 7), and fear ratings of three ( n  = 8).

Content of fears. Participants produced vivid descriptions to illustrate the shapes and sensations associated with their FoDR. For some, FoDR resembled specific memories of past MDEs ( n  = 11, 33%), an all-encompassing darkness ( n  = 9, 20%), or feelings of being trapped ( n  = 7, 17%). Participant FD22 described their FoDR as:

“Terrible darkness. Like a hole where I’m going to fall into. And pain, a lot of pain. And if I fall into that all I will never be able to climb back. […]. It’s like a terror. It feels like I’m terrorized that if I fall, that’s it.”

Participants expressed fears related to re-experiencing core MDE symptoms including depressed mood ( n  = 42, 70%), sleep difficulties ( n  = 25, 57%), anhedonia ( n  = 26, 40%), negative cognitions ( n  = 18, 37%), feelings of worthlessness, guilt, and self-criticism ( n  = 18, 40%), weight and/or appetites changes ( n  = 13, 30%), and suicidal ideation and/or non-suicidal self-injury ( n  = 12, 27%). Participant FD01 reported FoDR including:

“Sleeping all the time and […] not maintaining my friendships and relationships. Not talking to anyone. […]. I won’t eat well, so then, like, I’ll gain weight, and then I just won’t like the way I look.”

Participants’ FoDR were also centered around re-experiencing similar interpersonal consequences or challenges faced during past MDEs. These fears included experiencing difficulties socializing (e.g., feeling alone/isolated, withdrawing from others; n  = 43, 63%) and negative social evaluation (e.g., burdening others; n  = 32, 53%). Participant FD05 described:

“ For me it’s mostly feeling detached from everything. Because right now I feel like I’m in a situation where I’m surrounded by good people, my friends, my work environment, all of that. And I worry that if I go back to the depression, feeling emotionally detached from everyone, it’s just gonna ruin a lot of good friendships.”

Participants expressed fears related to the uncertainty of how another MDE would impact their life ( n  = 37, 50%), including concerns about goal achievement, falling behind, and losing the progress made since their last MDE. Participant FD14 reported:

“I would lose this happy life that I have right now. Like that just feeling okay would go away. So that’s definitely a scary thing.”

Participants’ fears also included experiencing occupational and academic consequences ( n  = 30, 50%), difficulties with personal functioning ( n  = 24, 43%), and reduced self-efficacy ( n  = 14, 30%).

Triggers of fears. The two most frequently mentioned triggers of FoDR included re-experiencing MDE symptoms ( n  = 73, 83%) and reminders of past MDEs or difficult life experiences ( n  = 40, 60%). Some participants reported increased FoDR when struggling academically or occupationally ( n  = 33, 50%), when feeling overwhelmed and stressed ( n  = 23, 47%), and when experiencing difficulties functioning ( n  = 13, 23%). Examples of reported interpersonal triggers included dealing with interpersonal conflict ( n  = 27, 47%), feeling alone and unsupported ( n  = 20, 47%), and experiencing grief or loss ( n  = 9, 20%). Participants also described experiencing FoDR in response to uncertainty about the future ( n  = 23, 40%), having to make life decisions and future plans ( n  = 12, 17%), undergoing a transition ( n  = 10, 23%), and when facing negative life events ( n  = 20, 43%).

Impact of FoDR on daily functioning. Some participants reported a negative impact of FoDR on daily functioning. FoDR was associated with increased anxiety ( n  = 23, 57%), negative mood changes (e.g., sadness; n  = 21, 47%), academic and/or occupational consequences ( n  = 16, 33%), and sleep difficulties ( n  = 5, 10%). Participant FD30 described that their FoDR:

“Seem like a huge deal, I definitely can get a lot of anxiety over them. I can be really insanely upset over them. Again, like I’ve lost sleep over it.”

Others described a “snowball effect” ( n  = 13, 37%), where FoDR led them to be increasingly hypervigilant to symptom changes, more overwhelmed, and at a greater perceived risk of MDE recurrence. FoDR also impacted participants’ engagement in specific behaviours ( n  = 15, 20%), including avoiding triggers of past MDEs, reducing responsibilities, and less risk-taking. For some, FoDR influenced future decision making and choices through exercising greater caution surrounding transitions and an increased sense of urgency when decision-making ( n  = 13, 17%). Participant FD08 describes how they:

“Definitely don’t do the same things I used to before. Like, I’m not the same person, it’s been eight years. But I do feel like there was a shift in my personality from before and after my depression, like, I’m a lot less of a risk taker. I’m a lot less, you know, worry-free, I am more careful, I’m more aware.”

FoDR also led to positive behavioural and personal changes. For some, FoDR led to greater engagement in health behaviours (n = 28, 40%), including trying to proactively address early warning signs of another MDE. FoDR was also associated with positive personality changes and growth ( n  = 17, 30%), including increased confidence and greater awareness of one’s mental health needs. Participant FD05 described how their FoDR:

“Impacted [me] in a good way, because it makes me recognize some warning signs before they get bad. […]. If I’m maybe taking less care of myself, sleeping less, working too much until like I can’t focus on things anymore, I started to recognize that as a warning sign. And I kind of take a step back and focus on getting back to a structured routine, so it doesn’t get worse.”

Some participants reported that FoDR had no or little impact on daily functioning ( n  = 28, 50%):

“I don’t worry as much. The worry doesn’t last that long. So definitely no impact on my life. And emotionally too. […]. I wouldn’t say it affect[s] that much.” [FD02].

Coping with FoDR. Participants commonly reported using cognitive strategies (e.g., acceptance, distraction; n  = 79, 97%) and shifting their perspectives to be more positive and open ( n  = 23, 50%) to cope with FoDR. Participant FD20 described their coping style as:

“Just more like accepting. Like, if it does come back […], I kind of like, know it’s not a forever thing. And I know, generally, like, I have strategies to help me.”

Social support ( n  = 41, 67%), including interacting with friends, family, and engaging in social activities, was also helpful in managing FoDR. Participant FD12 described that their “ tool for addressing those thoughts coming back is just talking about it more.”. Some participants used behavioural strategies to cope with FoDR including engaging in health behaviours (e.g., exercise; n  = 35, 60%), directly addressing sources of FoDR ( n  = 14, 33%), relaxation strategies (e.g., mindfulness; n  = 15, 37%), and participating in mastery-oriented activities (e.g., cleaning; n  = 10, 23%). Others sought help from a mental health professional (e.g., therapy, psychiatrist; n  = 15, 33%). Participant FD30 described their coping:

“ I write in a journal and I display my thoughts. So [my FoDR] doesn’t last more than a couple of hours I, if I’m really feeling scared or anxious, I will speak to someone, or I will check in with myself [as] I don’t want [it] to get to be something really big.”

For some, understanding and accepting one’s relationship with depression ( n  = 37, 60%), including greater awareness of the signs of an incoming MDE, helped mitigate FoDR. Other FoDR coping strategies included developing a more balanced and/or positive view of the self (e.g., adjusting expectations; n  = 27, 37%).

Situations that reduce FoDR. Participants reported that feeling competent, productive, and accomplished ( n  = 9, 27%), experiencing positive social interactions and/or feeling supported ( n  = 8, 27%), distraction ( n  = 8, 23%), and mood improvements ( n  = 8, 27%) reduced FoDR.

To our knowledge, this is the first study to explicitly examine FoDR among individuals with remitted MDD. Most of our sample (73%) reported FoDR, with these fears often occurring monthly or weekly and lasting minutes or hours. The most frequently mentioned triggers of FoDR included re-experiencing depression symptoms, reminders of past MDEs, and interpersonal conflict. The content of participants' FoDR varied, with participants most commonly reporting fears related to re-experiencing MDE symptoms, difficulties socializing, academic and occupational challenges, and uncertainty about the future.

There was substantial overlap between the reported triggers and content of participants’ FoDR. Participants described how negative interpersonal experiences, difficulties functioning at work, home, or at school, and re-experiencing MDE symptoms served as both triggers for and content of their FoDR. Other reported triggers included transitions, reminders of past MDEs, and decision making. These triggers overlapped with participants’ fears surrounding the uncertainty of having another MDE and the impact it would have on them. Although some content and triggers of FoDR were unique to depression, similarities emerged with what is known about FIR in cancer. For example, symptom changes (e.g., pain) and reminders of past cancer experiences are also documented triggers of FIR and some cancer survivors have endorsed fears related to the uncertainty of their futures, burdening others, and loss of independence [ 13 , 54 ]. Similarly, participants in the present study described reminders of past MDEs as a key trigger of FoDR. Contrary to the fear of cancer recurrence literature, participants in this study did not report fears related to dying, experiencing physical pain, and undergoing treatments (e.g., chemotherapy) [ 54 ]. Notably, interpersonal factors, including conflict with friends and/or family and the potential loss of a relationship (e.g., grief, break ups), were reported as triggers of FoDR, representing factors that may distinguish FoDR from FIR more broadly.

Participants’ experiences of FoDR offer evidence for the cyclical nature of MDD. Both the triggers and content of participants’ FoDR were linked to the triggers, symptoms, and consequences of their past MDEs. Participants expressed concerns that if they were to have another MDE, they would have to endure the same symptoms and challenges previously experienced. Achieving full remission from depression is complex, and research investigating the course of depression is often criticized for a lack of consensus about key points of change within the depression cycle [ 55 , 56 ]. Although at the time of the study all participants met criteria for remission from MDD, our findings indicate that the impact of having endured an MDE (e.g., life consequences, behavioural changes), influenced participants’ FoDR. These findings support the idea that deficits in functioning and other longstanding consequences of MDEs (i.e., changes in self-perception) may remit slower than acute MDE symptoms and contribute to the resurgence of residual symptoms and MDE recurrence through means of FoDR [ 57 , 58 ]. Indeed, the presence of residual symptoms is a well-established and robust predictor of MDE recurrence [ 10 ], providing support that the present fears around past depressive symptoms and consequences may signify risk for relapse.

Participants used similar coping strategies in response to FoDR that they reported using during past MDEs (e.g., cognitive strategies, professional help). Participants indicated that reflecting on their experiences with MDD helped them to develop a more balanced and positive view of themselves and accept their depression histories, which, in turn, helped them cope with FoDR. Similar coping strategies have been reported in other qualitative studies of depression [ 59 , 60 , 61 ]. However, it was sometimes challenging for participants to discern when in the depression cycle specific coping strategies were used (i.e., during past MDEs, in response to FoDR, in the ongoing management of one’s general mental health, or to cope with recurrent symptoms). These findings suggest that we have yet to understand how and when in the depression cycle these strategies are used.

The impact of FoDR on participants’ daily lives varied substantially. Notably, 50% of our sample reported that FoDR had little or no impact on their lives. For others, FoDR had a negative impact, including posing challenges to decision making, negatively affecting one’s mood, academic and occupational consequences, and functional impairments. Conversely, some participants reported that FoDR positively impacted their lives by fostering personal growth and motivating them to engage in health behaviours to reduce the risk of MDE recurrence. Similar impacts of FoDR on functioning and self-perceptions were described by Coyne et al. [ 11 ] who found that living through an MDE provided some participants with a renewed sense of strength, whereas others felt pressured to continuously manage their mental health and reduce risk taking. The multidimensional impact of FoDR reported in this study complements what we know about FIR in cancer. Fear of cancer recurrence has been associated with greater depression and anxiety symptoms, reduced quality of life, reduced engagement in social activities, and limited coping [ 13 , 17 , 62 , 63 ]. Positive influences of FIR in cancer have also been reported including serving as a motivator to better manage one’s illness through self-care, positive coping, and symptom monitoring [ 13 , 19 ].

Future directions

Identifying the factors that influence how one responds to FoDR will help us differentiate why some individuals report no impact or a positive impact of FoDR whereas others describe a negative influence on daily functioning. Future research should explore whether individual (e.g., neuroticism, FoDR severity, coping) and/or characteristics of the disorder (e.g., duration and severity of past MDEs) influence the presence and impact of FoDR on daily functioning, mood, cognitions, and behaviours. For example, 26% of our sample reported having a comorbid anxiety disorder and 48% endorsed a history of more than three past MDEs. It would be beneficial to examine whether a history of recurrent MDD and/or having an anxiety disorder are contributing to the presence of FoDR and its negative impact on functioning. Further, identifying the factors that explain the variance in how our participants responded to and perceived their FoDR may allow for the development of more tailored treatment and relapse prevention protocols for individuals with remitted MDD endorsing FoDR. This knowledge may also provide an avenue to further explore potential “at risk” profiles of individuals with remitted MDD who may be at higher risk of MDE recurrence through engagement in specific cognitive and behavioural changes associated with FoDR. Similarly, knowledge of the underlying characteristics leading individuals to respond positively to FoDR (e.g., personal growth, greater engagement in health behaviours), may lead to the identification of targetable factors in relapse prevention interventions for recurrent MDD.

The substantial overlap between the content and triggers of participants’ FoDR with their past MDE experiences, confounded by the presence of residual symptoms, offers evidence for the cyclical, dynamic, and constantly changing nature of MDD. Given this, we recommend viewing FoDR as a dynamic construct that may wax and wane in intensity and severity as one progresses through the depression cycle. Thus, it is important to examine the presence and impact of FoDR longitudinally, to explore whether FoDR and one’s response to these fears may evolve based on disorder-specific, environmental, situational, and individual changes.

Future research should also consider the similarities and differences of the nature and impact of FIR across both psychiatric (e.g., depression, psychotic disorders) and medical conditions (e.g., cancer). For example, perhaps people’s perceptions of their illness and the level of perceived control they have over the resurgence of symptoms may differ dramatically between those with a psychiatric condition (i.e., depression) versus a physical one (i.e., skin cancer). These potential differences may then inform the presence of FoDR and the extent of impact associated with these fears. Finally, future FIR research would benefit from interdisciplinary research collaborations aimed at identifying the elements of FIR that may present transdiagnostically across both psychiatric and medical conditions.

Given the intersecting influence of an individual’s past MDE on FoDR, future research should focus on disentangling how residual depression symptoms and consequences of past MDEs relate to FoDR and influence MDD prognosis. To do this, it may be beneficial to include participants endorsing residual symptoms of MDD within future studies of FoDR. However, prior to being able to quantitatively examine FoDR and its relationship to health outcomes, personality characteristics, and other indices of functioning, a psychometrically valid measure of FoDR must be developed. This measure should be designed to capture the unique elements of MDD that are not otherwise represented across measures of FIR in cancer and other chronic illnesses.

Several limitations are worth noting. Firstly, all interviews were conducted online, which may have influenced the willingness of participants to speak candidly about their experiences. Secondly, although our sample was adequate in size and we achieved data saturation, we did not conduct subgroup analyses with unique depression subtypes (i.e., recurrent vs. single episode MDD) or based on any sociocultural factors. Therefore, we are unable to draw conclusions about whether there are differences in the experiences of FoDR across clinical and sociocultural variables. Thirdly, some participants, particularly those with long durations since the end of their last MDEs, may have experienced memory bias, thus influencing the accuracy of their ability to recall important details about their past MDEs and current FoDR. However, we chose to recruit broadly to ensure that our final sample contained participants with a wide range of experiences and diverse characteristics. Fourthly, we did not use a quantitative estimate of intercoder reliability, which may limit the objectivity and reliability of our analyses and interpretations. However, aligned with the recommendations proposed in the COREQ [ 29 ] and SRQR [ 30 ] guidelines to enhance credibility, our data analysis approach involved multiple coders, clear descriptions of how we engaged with and analyzed the data, and transparency in how we developed our final codebook. We also included many supporting quotations from different participants both within our results and in Additional File 2 to enhance the transparency and trustworthiness of our findings and interpretations of the data.

Finally, although we used both the MINI diagnostic interview and the PHQ-8 to screen out participants with current depressive symptoms, results from the self-reported BDI-II scores indicated that some participants endorsed minimal depressive symptoms during the study. It is possible that having current depressive symptoms confounded a participants’ experiences with FoDR. It is also possible that not including participants with residual symptoms compromised the generalizability of our findings as it is common for individuals in remission from MDD to endorse the presence of and fluctuations in residual symptoms. These findings also highlight the importance of differentiating FoDR from residual depression symptoms.

We used semi-structured interviews to gain a thorough and nuanced understanding of the different content, triggers, severity, and impact of a participants’ FoDR. Our findings paralleled what we know about FIR in other health conditions and uniquely captured the lived experience of individuals with remitted MDD. Understanding the diverse impact that FoDR has on daily functioning and MDD prognosis may present a window into understanding the mechanisms influencing MDE recurrence.

Data availability

The datasets generated and analyzed during the current study are not publicly available due to concerns about revealing the individual privacy and identities of participants but are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank all participants for being open about their experiences with depression and for providing their valuable time and energy to make this research possible. We would also like to thank Gabriela Kennedy for her help preparing Additional File 2 .

This work was supported by the Canadian Institutes of Health Research (Grant #378786). STG was supported by the Social Sciences and Humanities Research Council, Concordia University’s PERFORM Centre, and IODE Canada.

The funding sources had no role in the study design, data collection, analysis and interpretation, manuscript composition, or the decision to submit the article for publication.

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STG, AB, and ME were involved in study conceptualization and design. LH, AB, and STG conducted the data collection, analysis, and interpretation of data. STG drafted the initial manuscript. All authors reviewed and revised the manuscript and approved the final manuscript submission.

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Additional file 1: Qualitative interview guide

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Additional file 2: Codebook containing all codes, categories, subcategories, code definitions, example quotations, and number of code mentions

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Gumuchian, S.T., Boyle, A., Hazel, L.H. et al. Fear of depression recurrence among individuals with remitted depression: a qualitative interview study. BMC Psychiatry 24 , 152 (2024). https://doi.org/10.1186/s12888-024-05588-4

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