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Qualitative Research Part II: Participants, Analysis, and Quality Assurance

This is the second of a two-part series on qualitative research. Part 1 in the December 2011 issue of Journal of Graduate Medical Education provided an introduction to the topic and compared characteristics of quantitative and qualitative research, identified common data collection approaches, and briefly described data analysis and quality assessment techniques. Part II describes in more detail specific techniques and methods used to select participants, analyze data, and ensure research quality and rigor.

If you are relatively new to qualitative research, some references you may find especially helpful are provided below. The two texts by Creswell 2008 and 2009 are clear and practical. 1 , 2 In 2008, the British Medical Journal offered a series of short essays on qualitative research; the references provided are easily read and digested. 3 – , 8 For those wishing to pursue qualitative research in more detail, a suggestion is to start with the appropriate chapters in Creswell 2008, 1 and then move to the other texts suggested. 9 – , 11

To summarize the previous editorial, while quantitative research focuses predominantly on the impact of an intervention and generally answers questions like “did it work?” and “what was the outcome?”, qualitative research focuses on understanding the intervention or phenomenon and exploring questions like “why was this effective or not?” and “how is this helpful for learning?” The intent of qualitative research is to contribute to understanding. Hence, the research procedures for selecting participants, analyzing data, and ensuring research rigor differ from those for quantitative research. The following sections address these approaches. table 1 provides a comparative summary of methodological approaches for quantitative and qualitative research.

A Comparison of Qualitative and Quantitative Methodological Approaches

Data collection methods most commonly used in qualitative research are individual or group interviews (including focus groups), observation, and document review. They can be used alone or in combination. While the following sections are written in the context of using interviews or focus groups to collect data, the principles described for sample selection, data analysis, and quality assurance are applicable across qualitative approaches.

Selecting Participants

Quantitative research requires standardization of procedures and random selection of participants to remove the potential influence of external variables and ensure generalizability of results. In contrast, subject selection in qualitative research is purposeful; participants are selected who can best inform the research questions and enhance understanding of the phenomenon under study. 1 , 8 Hence, one of the most important tasks in the study design phase is to identify appropriate participants. Decisions regarding selection are based on the research questions, theoretical perspectives, and evidence informing the study.

The subjects sampled must be able to inform important facets and perspectives related to the phenomenon being studied. For example, in a study looking at a professionalism intervention, representative participants could be considered by role (residents and faculty), perspective (those who approve/disapprove the intervention), experience level (junior and senior residents), and/or diversity (gender, ethnicity, other background).

The second consideration is sample size. Quantitative research requires statistical calculation of sample size a priori to ensure sufficient power to confirm that the outcome can indeed be attributed to the intervention. In qualitative research, however, the sample size is not generally predetermined. The number of participants depends upon the number required to inform fully all important elements of the phenomenon being studied. That is, the sample size is sufficient when additional interviews or focus groups do not result in identification of new concepts, an end point called data saturation . To determine when data saturation occurs, analysis ideally occurs concurrently with data collection in an iterative cycle. This allows the researcher to document the emergence of new themes and also to identify perspectives that may otherwise be overlooked. In the professionalism intervention example, as data are analyzed, the researchers may note that only positive experiences and views are being reported. At this time, a decision could be made to identify and recruit residents who perceived the experience as less positive.

Data Analysis

The purpose of qualitative analysis is to interpret the data and the resulting themes, to facilitate understanding of the phenomenon being studied. It is often confused with content analysis, which is conducted to identify and describe results. 12 In the professionalism intervention example, content analysis of responses might report that residents identified the positive elements of the innovation to be integration with real patient cases, opportunity to hear the views of others, and time to reflect on one's own professionalism. An interpretive analysis, on the other hand, would seek to understand these responses by asking questions such as, “Were there conditions that most frequently elicited these positive responses?” Further interpretive analysis might show that faculty engagement influenced the positive responses, with more positive features being described by residents who had faculty who openly reflected upon their own professionalism or who asked probing questions about the cases. This interpretation can lead to a deeper understanding of the results and to new ideas or theories about relationships and/or about how and why the innovation was or was not effective.

Interpretive analysis is generally seen as being conducted in 3 stages: deconstruction, interpretation, and reconstruction. 11 These stages occur after preparing the data for analysis, ie, after transcription of the interviews or focus groups and verification of the transcripts with the recording.

• Deconstruction refers to breaking down data into component parts in order to see what is included. It is similar to content analysis mentioned above. It requires reading and rereading interview or focus group transcripts and then breaking down data into categories or codes that describe the content.
• Interpretation follows deconstruction and refers to making sense of and understanding the coded data. It involves comparing data codes and categories within and across transcripts and across variables deemed important to the study (eg, year of residency, discipline, engagement of faculty). Techniques for interpreting data and findings include discussion and comparison of codes among research team members while purposefully looking for similarities and differences among themes, comparing findings with those of other studies, exploring theories which might explain relationships among themes, and exploring negative results (those that do not confirm the dominant themes) in more detail.
• Reconstruction refers to recreating or repackaging the prominent codes and themes in a manner that shows the relationships and insights derived in the interpretation phase and that explains them more broadly in light of existing knowledge and theoretical perspectives. Generally one or two central concepts will emerge as central or overarching, and others will appear as subthemes that further contribute to the central concepts. Reconstruction requires contextualizing the findings, ie, positioning and framing them within existing theory, evidence, and practice.

Ensuring Research Quality and Rigor

Within qualitative research, two main strategies promote the rigor and quality of the research: ensuring the quality or “authenticity” of the data and the quality or “trustworthiness” of the analysis. 8 , 12 These are similar in many ways to ensuring validity and reliability, respectively, in quantitative research.

 1. Authenticity of the data refers to the quality of the data and data collection procedures. Elements to consider include:

  • Sampling approach and participant selection to enable the research question to be addressed appropriately (see “Selecting Participants” above) and reduce the potential of having a biased sample.

  •  Data triangulation refers to using multiple data sources to produce a more comprehensive view of the phenomenon being studied, eg, interviewing both residents and faculty and using multiple residency sites and/or disciplines.

  • Using the appropriate method to answer the research questions, considering the nature of the topic being explored, eg, individual interviews rather than focus groups are generally more appropriate for topics of a sensitive nature.

  • Using interview and other guides that are not biased or leading, ie, that do not ask questions in a way that may lead the participant to answer in a particular manner.

  • The researcher's and research team's relationships to the study setting and participants need to be explicit, eg, describe the potential for coercion when a faculty member requests his or her own residents to participate in a study.

  • The researcher's and team members' own biases and beliefs relative to the phenomenon under study must be made explicit, and, when necessary, appropriate steps must be taken to reduce their impact on the quality of data collected, eg, by selecting a neutral “third party” interviewer.

 2. Trustworthiness of the analysis refers to the quality of data analysis. Elements to consider when assessing the quality of analysis include:

  • Analysis process: is this clearly described, eg, the roles of the team members, what was done, timing, and sequencing? Is it clear how the data codes or categories were developed? Does the process reflect best practices, eg, comparison of findings within and among transcripts, and use of memos to record decision points?

  • Procedure for resolving differences in findings and among team members: this needs to be clearly described.

  • Process for addressing the potential influence the researchers' views and beliefs may have upon the analysis.

  • Use of a qualitative software program: if used, how was this used?

In summary, this editorial has addressed 3 components of conducting qualitative research: selecting participants, performing data analysis, and assuring research rigor and quality. See table 2 for the key elements for each of these topics.

Conducting Qualitative Research: Summary of Key Elements

JGME editors look forward to reading medical education papers employing qualitative methods and perspectives. We trust these two editorials may be helpful to potential authors and readers, and we welcome your comments on this subject.

Joan Sargeant, PhD, is Professor in the Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada.

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• What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

Published on 4 April 2022 by Pritha Bhandari . Revised on 30 January 2023.

Qualitative research involves collecting and analysing 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 analysing 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, and history.

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Table of contents

Approaches to qualitative research, qualitative research methods, qualitative data analysis, advantages of qualitative research, disadvantages of qualitative research, 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 emphasise different aims and perspectives.

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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 analysing 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 organise 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 categorise 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 analysing qualitative data. Although these methods share similar processes, they emphasise 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 analysing 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 analysing 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 generalisability

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

• Labour-intensive

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

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

Quantitative methods allow you to test a hypothesis by systematically collecting and analysing data, while qualitative methods allow you to explore ideas and experiences in depth.

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 organisation 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 organisations.

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

• Prepare and organise 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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Qualitative research: methods and examples

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13 April 2023

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Qualitative research involves gathering and evaluating non-numerical information to comprehend concepts, perspectives, and experiences. It’s also helpful for obtaining in-depth insights into a certain subject or generating new research ideas. 

As a result, qualitative research is practical if you want to try anything new or produce new ideas.

There are various ways you can conduct qualitative research. In this article, you'll learn more about qualitative research methodologies, including when you should use them.

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• What is qualitative research?

Qualitative research is a broad term describing various research types that rely on asking open-ended questions. Qualitative research investigates “how” or “why” certain phenomena occur. It is about discovering the inherent nature of something.

The primary objective of qualitative research is to understand an individual's ideas, points of view, and feelings. In this way, collecting in-depth knowledge of a specific topic is possible. Knowing your audience's feelings about a particular subject is important for making reasonable research conclusions.

Unlike quantitative research , this approach does not involve collecting numerical, objective data for statistical analysis. Qualitative research is used extensively in education, sociology, health science, history, and anthropology.

• Types of qualitative research methodology

Typically, qualitative research aims at uncovering the attitudes and behavior of the target audience concerning a specific topic. For example,  “How would you describe your experience as a new Dovetail user?”

Some of the methods for conducting qualitative analysis include:

Focus groups

Hosting a focus group is a popular qualitative research method. It involves obtaining qualitative data from a limited sample of participants. In a moderated version of a focus group, the moderator asks participants a series of predefined questions. They aim to interact and build a group discussion that reveals their preferences, candid thoughts, and experiences.

Unmoderated, online focus groups are increasingly popular because they eliminate the need to interact with people face to face.

Focus groups can be more cost-effective than 1:1 interviews or studying a group in a natural setting and reporting one’s observations.

Focus groups make it possible to gather multiple points of view quickly and efficiently, making them an excellent choice for testing new concepts or conducting market research on a new product.

However, there are some potential drawbacks to this method. It may be unsuitable for sensitive or controversial topics. Participants might be reluctant to disclose their true feelings or respond falsely to conform to what they believe is the socially acceptable answer (known as response bias).

Case study research

A case study is an in-depth evaluation of a specific person, incident, organization, or society. This type of qualitative research has evolved into a broadly applied research method in education, law, business, and the social sciences.

Even though case study research may appear challenging to implement, it is one of the most direct research methods. It requires detailed analysis, broad-ranging data collection methodologies, and a degree of existing knowledge about the subject area under investigation.

Historical model

The historical approach is a distinct research method that deeply examines previous events to better understand the present and forecast future occurrences of the same phenomena. Its primary goal is to evaluate the impacts of history on the present and hence discover comparable patterns in the present to predict future outcomes.

Oral history

This qualitative data collection method involves gathering verbal testimonials from individuals about their personal experiences. It is widely used in historical disciplines to offer counterpoints to established historical facts and narratives. The most common methods of gathering oral history are audio recordings, analysis of auto-biographical text, videos, and interviews.

Qualitative observation

One of the most fundamental, oldest research methods, qualitative observation , is the process through which a researcher collects data using their senses of sight, smell, hearing, etc. It is used to observe the properties of the subject being studied. For example, “What does it look like?” As research methods go, it is subjective and depends on researchers’ first-hand experiences to obtain information, so it is prone to bias. However, it is an excellent way to start a broad line of inquiry like, “What is going on here?”

Record keeping and review

Record keeping uses existing documents and relevant data sources that can be employed for future studies. It is equivalent to visiting the library and going through publications or any other reference material to gather important facts that will likely be used in the research.

Grounded theory approach

The grounded theory approach is a commonly used research method employed across a variety of different studies. It offers a unique way to gather, interpret, and analyze. With this approach, data is gathered and analyzed simultaneously.  Existing analysis frames and codes are disregarded, and data is analyzed inductively, with new codes and frames generated from the research.

Ethnographic research

Ethnography  is a descriptive form of a qualitative study of people and their cultures. Its primary goal is to study people's behavior in their natural environment. This method necessitates that the researcher adapts to their target audience's setting. 

Thereby, you will be able to understand their motivation, lifestyle, ambitions, traditions, and culture in situ. But, the researcher must be prepared to deal with geographical constraints while collecting data i.e., audiences can’t be studied in a laboratory or research facility.

This study can last from a couple of days to several years. Thus, it is time-consuming and complicated, requiring you to have both the time to gather the relevant data as well as the expertise in analyzing, observing, and interpreting data to draw meaningful conclusions.

Narrative framework

A narrative framework is a qualitative research approach that relies on people's written text or visual images. It entails people analyzing these events or narratives to determine certain topics or issues. With this approach, you can understand how people represent themselves and their experiences to a larger audience.

Phenomenological approach

The phenomenological study seeks to investigate the experiences of a particular phenomenon within a group of individuals or communities. It analyzes a certain event through interviews with persons who have witnessed it to determine the connections between their views. Even though this method relies heavily on interviews, other data sources (recorded notes), and observations could be employed to enhance the findings.

• Qualitative research methods (tools)

Some of the instruments involved in qualitative research include:

Document research: Also known as document analysis because it involves evaluating written documents. These can include personal and non-personal materials like archives, policy publications, yearly reports, diaries, or letters.

Focus groups:  This is where a researcher poses questions and generates conversation among a group of people. The major goal of focus groups is to examine participants' experiences and knowledge, including research into how and why individuals act in various ways.

Secondary study: Involves acquiring existing information from texts, images, audio, or video recordings.

Observations:   This requires thorough field notes on everything you see, hear, or experience. Compared to reported conduct or opinion, this study method can assist you in getting insights into a specific situation and observable behaviors.

Structured interviews :  In this approach, you will directly engage people one-on-one. Interviews are ideal for learning about a person's subjective beliefs, motivations, and encounters.

Surveys:  This is when you distribute questionnaires containing open-ended questions

• What are common examples of qualitative research?

Everyday examples of qualitative research include:

Conducting a demographic analysis of a business

For instance, suppose you own a business such as a grocery store (or any store) and believe it caters to a broad customer base, but after conducting a demographic analysis, you discover that most of your customers are men.

You could do 1:1 interviews with female customers to learn why they don't shop at your store.

In this case, interviewing potential female customers should clarify why they don't find your shop appealing. It could be because of the products you sell or a need for greater brand awareness, among other possible reasons.

Launching or testing a new product

Suppose you are the product manager at a SaaS company looking to introduce a new product. Focus groups can be an excellent way to determine whether your product is marketable.

In this instance, you could hold a focus group with a sample group drawn from your intended audience. The group will explore the product based on its new features while you ensure adequate data on how users react to the new features. The data you collect will be key to making sales and marketing decisions.

Conducting studies to explain buyers' behaviors

You can also use qualitative research to understand existing buyer behavior better. Marketers analyze historical information linked to their businesses and industries to see when purchasers buy more.

Qualitative research can help you determine when to target new clients and peak seasons to boost sales by investigating the reason behind these behaviors.

• Qualitative research: data collection

Data collection is gathering information on predetermined variables to gain appropriate answers, test hypotheses, and analyze results. Researchers will collect non-numerical data for qualitative data collection to obtain detailed explanations and draw conclusions.

To get valid findings and achieve a conclusion in qualitative research, researchers must collect comprehensive and multifaceted data.

Qualitative data is usually gathered through interviews or focus groups with videotapes or handwritten notes. If there are recordings, they are transcribed before the data analysis process. Researchers keep separate folders for the recordings acquired from each focus group when collecting qualitative research data to categorize the data.

• Qualitative research: data analysis

Qualitative data analysis is organizing, examining, and interpreting qualitative data. Its main objective is identifying trends and patterns, responding to research questions, and recommending actions based on the findings. Textual analysis is a popular method for analyzing qualitative data.

Textual analysis differs from other qualitative research approaches in that researchers consider the social circumstances of study participants to decode their words, behaviors, and broader meaning. 

Learn more about qualitative research data analysis software

• When to use qualitative research

Qualitative research is helpful in various situations, particularly when a researcher wants to capture accurate, in-depth insights. 

Here are some instances when qualitative research can be valuable:

Examining your product or service to improve your marketing approach

When researching market segments, demographics, and customer service teams

Identifying client language when you want to design a quantitative survey

When attempting to comprehend your or someone else's strengths and weaknesses

Assessing feelings and beliefs about societal and public policy matters

Collecting information about a business or product's perception

Analyzing your target audience's reactions to marketing efforts

When launching a new product or coming up with a new idea

When seeking to evaluate buyers' purchasing patterns

• Qualitative research methods vs. quantitative research methods

Qualitative research examines people's ideas and what influences their perception, whereas quantitative research draws conclusions based on numbers and measurements.

Qualitative research is descriptive, and its primary goal is to comprehensively understand people's attitudes, behaviors, and ideas.

In contrast, quantitative research is more restrictive because it relies on numerical data and analyzes statistical data to make decisions. This research method assists researchers in gaining an initial grasp of the subject, which deals with numbers. For instance, the number of customers likely to purchase your products or use your services.

What is the most important feature of qualitative research?

A distinguishing feature of qualitative research is that it’s conducted in a real-world setting instead of a simulated environment. The researcher is examining actual phenomena instead of experimenting with different variables to see what outcomes (data) might result.

Can I use qualitative and quantitative approaches together in a study?

Yes, combining qualitative and quantitative research approaches happens all the time and is known as mixed methods research. For example, you could study individuals’ perceived risk in a certain scenario, such as how people rate the safety or riskiness of a given neighborhood. Simultaneously, you could analyze historical data objectively, indicating how safe or dangerous that area has been in the last year. To get the most out of mixed-method research, it’s important to understand the pros and cons of each methodology, so you can create a thoughtfully designed study that will yield compelling results.

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Your ultimate guide to qualitative research (with methods and examples).

16 min read You may be already using qualitative research and want to check your understanding, or you may be starting from the beginning. Learn about qualitative research methods and how you can best use them for maximum effect.

What is qualitative research?

Qualitative research is a research method that collects non-numerical data. Typically, it goes beyond the information that quantitative research provides (which we will cover below) because it is used to gain an understanding of underlying reasons, opinions, and motivations.

Qualitative research methods focus on the thoughts, feelings, reasons, motivations, and values of a participant, to understand why people act in the way they do .

In this way, qualitative research can be described as naturalistic research, looking at naturally-occurring social events within natural settings. So, qualitative researchers would describe their part in social research as the ‘vehicle’ for collecting the qualitative research data.

Qualitative researchers discovered this by looking at primary and secondary sources where data is represented in non-numerical form. This can include collecting qualitative research data types like quotes, symbols, images, and written testimonials.

These data types tell qualitative researchers subjective information. While these aren’t facts in themselves, conclusions can be interpreted out of qualitative that can help to provide valuable context.

Because of this, qualitative research is typically viewed as explanatory in nature and is often used in social research, as this gives a window into the behavior and actions of people.

It can be a good research approach for health services research or clinical research projects.

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Quantitative vs qualitative research

In order to compare qualitative and quantitative research methods, let’s explore what quantitative research is first, before exploring how it differs from qualitative research.

Quantitative research

Quantitative research is the research method of collecting quantitative research data – data that can be converted into numbers or numerical data, which can be easily quantified, compared, and analyzed .

Quantitative research methods deal with primary and secondary sources where data is represented in numerical form. This can include closed-question poll results, statistics, and census information or demographic data.

Quantitative research data tends to be used when researchers are interested in understanding a particular moment in time and examining data sets over time to find trends and patterns.

The difference between quantitative and qualitative research methodology

While qualitative research is defined as data that supplies non-numerical information, quantitative research focuses on numerical data.

In general, if you’re interested in measuring something or testing a hypothesis, use quantitative research methods. If you want to explore ideas, thoughts, and meanings, use qualitative research methods.

While qualitative research helps you to properly define, promote and sell your products, don’t rely on qualitative research methods alone because qualitative findings can’t always be reliably repeated. Qualitative research is directional, not empirical.

The best statistical analysis research uses a combination of empirical data and human experience ( quantitative research and qualitative research ) to tell the story and gain better and deeper insights, quickly.

Where both qualitative and quantitative methods are not used, qualitative researchers will find that using one without the other leaves you with missing answers.

For example, if a retail company wants to understand whether a new product line of shoes will perform well in the target market:

• Qualitative research methods could be used with a sample of target customers, which would provide subjective reasons why they’d be likely to purchase or not purchase the shoes, while
• Quantitative research methods into the historical customer sales information on shoe-related products would provide insights into the sales performance, and likely future performance of the new product range.

Approaches to qualitative research

There are five approaches to qualitative research methods:

• Grounded theory: Grounded theory relates to where qualitative researchers come to a stronger hypothesis through induction, all throughout the process of collecting qualitative research data and forming connections. After an initial question to get started, qualitative researchers delve into information that is grouped into ideas or codes, which grow and develop into larger categories, as the qualitative research goes on. At the end of the qualitative research, the researcher may have a completely different hypothesis, based on evidence and inquiry, as well as the initial question.
• Ethnographic research : Ethnographic research is where researchers embed themselves into the environment of the participant or group in order to understand the culture and context of activities and behavior. This is dependent on the involvement of the researcher, and can be subject to researcher interpretation bias and participant observer bias . However, it remains a great way to allow researchers to experience a different ‘world’.
• Action research: With the action research process, both researchers and participants work together to make a change. This can be through taking action, researching and reflecting on the outcomes. Through collaboration, the collective comes to a result, though the way both groups interact and how they affect each other gives insights into their critical thinking skills.
• Phenomenological research: Researchers seek to understand the meaning of an event or behavior phenomenon by describing and interpreting participant’s life experiences. This qualitative research process understands that people create their own structured reality (‘the social construction of reality’), based on their past experiences. So, by viewing the way people intentionally live their lives, we’re able to see the experiential meaning behind why they live as they do.
• Narrative research: Narrative research, or narrative inquiry, is where researchers examine the way stories are told by participants, and how they explain their experiences, as a way of explaining the meaning behind their life choices and events. This qualitative research can arise from using journals, conversational stories, autobiographies or letters, as a few narrative research examples. The narrative is subjective to the participant, so we’re able to understand their views from what they’ve documented/spoken.

Qualitative research methods can use structured research instruments for data collection, like:

Surveys for individual views

A survey is a simple-to-create and easy-to-distribute qualitative research method, which helps gather information from large groups of participants quickly. Traditionally, paper-based surveys can now be made online, so costs can stay quite low.

Qualitative research questions tend to be open questions that ask for more information and provide a text box to allow for unconstrained comments.

Examples include:

• Asking participants to keep a written or a video diary for a period of time to document their feelings and thoughts
• In-Home-Usage tests: Buyers use your product for a period of time and report their experience

Surveys for group consensus (Delphi survey)

A Delphi survey may be used as a way to bring together participants and gain a consensus view over several rounds of questions. It differs from traditional surveys where results go to the researcher only. Instead, results go to participants as well, so they can reflect and consider all responses before another round of questions are submitted.

This can be useful to do as it can help researchers see what variance is among the group of participants and see the process of how consensus was reached.

• Asking participants to act as a fake jury for a trial and revealing parts of the case over several rounds to see how opinions change. At the end, the fake jury must make a unanimous decision about the defendant on trial.
• Asking participants to comment on the versions of a product being developed , as the changes are made and their feedback is taken onboard. At the end, participants must decide whether the product is ready to launch .

Semi-structured interviews

Interviews are a great way to connect with participants, though they require time from the research team to set up and conduct, especially if they’re done face-to-face.

Researchers may also have issues connecting with participants in different geographical regions. The researcher uses a set of predefined open-ended questions, though more ad-hoc questions can be asked depending on participant answers.

• Conducting a phone interview with participants to run through their feedback on a product . During the conversation, researchers can go ‘off-script’ and ask more probing questions for clarification or build on the insights.

Focus groups

Participants are brought together into a group, where a particular topic is discussed. It is researcher-led and usually occurs in-person in a mutually accessible location, to allow for easy communication between participants in focus groups.

In focus groups , the researcher uses a set of predefined open-ended questions, though more ad-hoc questions can be asked depending on participant answers.

• Asking participants to do UX tests, which are interface usability tests to show how easily users can complete certain tasks

Direct observation

This is a form of ethnographic research where researchers will observe participants’ behavior in a naturalistic environment. This can be great for understanding the actions in the culture and context of a participant’s setting.

This qualitative research method is prone to researcher bias as it is the researcher that must interpret the actions and reactions of participants. Their findings can be impacted by their own beliefs, values, and inferences.

• Embedding yourself in the location of your buyers to understand how a product would perform against the values and norms of that society

Qualitative data types and category types

Qualitative research methods often deliver information in the following qualitative research data types:

• Written testimonials

Through contextual analysis of the information, researchers can assign participants to category types:

• Social class
• Political alignment
• Most likely to purchase a product
• Their preferred training learning style

Advantages of qualitative research

• Useful for complex situations: Qualitative research on its own is great when dealing with complex issues, however, providing background context using quantitative facts can give a richer and wider understanding of a topic. In these cases, quantitative research may not be enough.
• A window into the ‘why’: Qualitative research can give you a window into the deeper meaning behind a participant’s answer. It can help you uncover the larger ‘why’ that can’t always be seen by analyzing numerical data.
• Can help improve customer experiences: In service industries where customers are crucial, like in private health services, gaining information about a customer’s experience through health research studies can indicate areas where services can be improved.

Disadvantages of qualitative research

• You need to ask the right question: Doing qualitative research may require you to consider what the right question is to uncover the underlying thinking behind a behavior. This may need probing questions to go further, which may suit a focus group or face-to-face interview setting better.
• Results are interpreted: As qualitative research data is written, spoken, and often nuanced, interpreting the data results can be difficult as they come in non-numerical formats. This might make it harder to know if you can accept or reject your hypothesis.
• More bias: There are lower levels of control to qualitative research methods, as they can be subject to biases like confirmation bias, researcher bias, and observation bias. This can have a knock-on effect on the validity and truthfulness of the qualitative research data results.

How to use qualitative research to your business’s advantage?

Qualitative methods help improve your products and marketing in many different ways:

• Understand the emotional connections to your brand
• Identify obstacles to purchase
• Uncover doubts and confusion about your messaging
• Find missing product features
• Improve the usability of your website, app, or chatbot experience
• Learn about how consumers talk about your product
• See how buyers compare your brand to others in the competitive set
• Learn how an organization’s employees evaluate and select vendors

6 steps to conducting good qualitative research

Businesses can benefit from qualitative research by using it to understand the meaning behind data types. There are several steps to this:

• Define your problem or interest area: What do you observe is happening and is it frequent? Identify the data type/s you’re observing.
• Create a hypothesis: Ask yourself what could be the causes for the situation with those qualitative research data types.
• Plan your qualitative research: Use structured qualitative research instruments like surveys, focus groups, or interviews to ask questions that test your hypothesis.
• Data Collection: Collect qualitative research data and understand what your data types are telling you. Once data is collected on different types over long time periods, you can analyze it and give insights into changing attitudes and language patterns.
• Data analysis: Does your information support your hypothesis? (You may need to redo the qualitative research with other variables to see if the results improve)
• Effectively present the qualitative research data: Communicate the results in a clear and concise way to help other people understand the findings.

Qualitative data analysis

Evaluating qualitative research can be tough when there are several analytics platforms to manage and lots of subjective data sources to compare.

Qualtrics provides a number of qualitative research analysis tools, like Text iQ , powered by Qualtrics iQ, provides powerful machine learning and native language processing to help you discover patterns and trends in text.

This also provides you with:

• Sentiment analysis — a technique to help identify the underlying sentiment (say positive, neutral, and/or negative) in qualitative research text responses
• Topic detection/categorisation — this technique is the grouping or bucketing of similar themes that can are relevant for the business & the industry (eg. ‘Food quality’, ‘Staff efficiency’ or ‘Product availability’)

How Qualtrics products can enhance & simplify the qualitative research process

Even in today’s data-obsessed marketplace, qualitative data is valuable – maybe even more so because it helps you establish an authentic human connection to your customers. If qualitative research doesn’t play a role to inform your product and marketing strategy, your decisions aren’t as effective as they could be.

The Qualtrics XM system gives you an all-in-one, integrated solution to help you all the way through conducting qualitative research. From survey creation and data collection to textual analysis and data reporting, it can help all your internal teams gain insights from your subjective and categorical data.

Qualitative methods are catered through templates or advanced survey designs. While you can manually collect data and conduct data analysis in a spreadsheet program, this solution helps you automate the process of qualitative research, saving you time and administration work.

Using computational techniques helps you to avoid human errors, and participant results come in are already incorporated into the analysis in real-time.

Our key tools, Text IQ™ and Driver IQ™ make analyzing subjective and categorical data easy and simple. Choose to highlight key findings based on topic, sentiment, or frequency. The choice is yours.

Some examples of your workspace in action, using drag and drop to create fast data visualizations quickly:

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.

Ready to learn more about Qualtrics?

Qualitative Research: Characteristics, Design, Methods & Examples

Lauren McCall

MSc Health Psychology Graduate

MSc, Health Psychology, University of Nottingham

Lauren obtained an MSc in Health Psychology from The University of Nottingham with a distinction classification.

Learn about our Editorial Process

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

“Not everything that can be counted counts, and not everything that counts can be counted“ (Albert Einstein)

Qualitative research is a process used for the systematic collection, analysis, and interpretation of non-numerical data (Punch, 2013). 

Qualitative research can be used to: (i) gain deep contextual understandings of the subjective social reality of individuals and (ii) to answer questions about experience and meaning from the participant’s perspective (Hammarberg et al., 2016).

Unlike quantitative research, which focuses on gathering and analyzing numerical data for statistical analysis, qualitative research focuses on thematic and contextual information.

Characteristics of Qualitative Research 

Reality is socially constructed.

Qualitative research aims to understand how participants make meaning of their experiences – individually or in social contexts. It assumes there is no objective reality and that the social world is interpreted (Yilmaz, 2013). 

The primacy of subject matter 

The primary aim of qualitative research is to understand the perspectives, experiences, and beliefs of individuals who have experienced the phenomenon selected for research rather than the average experiences of groups of people (Minichiello, 1990).

Variables are complex, interwoven, and difficult to measure

Factors such as experiences, behaviors, and attitudes are complex and interwoven, so they cannot be reduced to isolated variables , making them difficult to measure quantitatively.

However, a qualitative approach enables participants to describe what, why, or how they were thinking/ feeling during a phenomenon being studied (Yilmaz, 2013). 

Emic (insider’s point of view)

The phenomenon being studied is centered on the participants’ point of view (Minichiello, 1990).

Emic is used to describe how participants interact, communicate, and behave in the context of the research setting (Scarduzio, 2017).

Why Conduct Qualitative Research? 

In order to gain a deeper understanding of how people experience the world, individuals are studied in their natural setting. This enables the researcher to understand a phenomenon close to how participants experience it. 

Qualitative research allows researchers to gain an in-depth understanding, which is difficult to attain using quantitative methods. 

An in-depth understanding is attained since qualitative techniques allow participants to freely disclose their experiences, thoughts, and feelings without constraint (Tenny et al., 2022). 

This helps to further investigate and understand quantitative data by discovering reasons for the outcome of a study – answering the why question behind statistics. 

The exploratory nature of qualitative research helps to generate hypotheses that can then be tested quantitatively (Busetto et al., 2020).

To design hypotheses, theory must be researched using qualitative methods to find out what is important in order to begin research. 

For example, by conducting interviews or focus groups with key stakeholders to discover what is important to them. 

Examples of qualitative research questions include: 

• How does stress influence young adults’ behavior?
• What factors influence students’ school attendance rates in developed countries?
• How do adults interpret binge drinking in the UK?
• What are the psychological impacts of cervical cancer screening in women?
• How can mental health lessons be integrated into the school curriculum? 

Collecting Qualitative Data

There are four main research design methods used to collect qualitative data: observations, interviews,  focus groups, and ethnography.

Observations

This method involves watching and recording phenomena as they occur in nature. Observation can be divided into two types: participant and non-participant observation.

In participant observation, the researcher actively participates in the situation/events being observed.

In non-participant observation, the researcher is not an active part of the observation and tries not to influence the behaviors they are observing (Busetto et al., 2020). 

Observations can be covert (participants are unaware that a researcher is observing them) or overt (participants are aware of the researcher’s presence and know they are being observed).

However, awareness of an observer’s presence may influence participants’ behavior. 

Interviews give researchers a window into the world of a participant by seeking their account of an event, situation, or phenomenon. They are usually conducted on a one-to-one basis and can be distinguished according to the level at which they are structured (Punch, 2013). 

Structured interviews involve predetermined questions and sequences to ensure replicability and comparability. However, they are unable to explore emerging issues.

Informal interviews consist of spontaneous, casual conversations which are closer to the truth of a phenomenon. However, information is gathered using quick notes made by the researcher and is therefore subject to recall bias. 

Semi-structured interviews have a flexible structure, phrasing, and placement so emerging issues can be explored (Denny & Weckesser, 2022).

The use of probing questions and clarification can lead to a detailed understanding, but semi-structured interviews can be time-consuming and subject to interviewer bias. 

Focus groups 

Similar to interviews, focus groups elicit a rich and detailed account of an experience. However, focus groups are more dynamic since participants with shared characteristics construct this account together (Denny & Weckesser, 2022).

A shared narrative is built between participants to capture a group experience shaped by a shared context. 

The researcher takes on the role of a moderator, who will establish ground rules and guide the discussion by following a topic guide to focus the group discussions.

Typically, focus groups have 4-10 participants as a discussion can be difficult to facilitate with more than this, and this number allows everyone the time to speak.

Ethnography

Ethnography is a methodology used to study a group of people’s behaviors and social interactions in their environment (Reeves et al., 2008).

Data are collected using methods such as observations, field notes, or structured/ unstructured interviews.

The aim of ethnography is to provide detailed, holistic insights into people’s behavior and perspectives within their natural setting. In order to achieve this, researchers immerse themselves in a community or organization. 

Due to the flexibility and real-world focus of ethnography, researchers are able to gather an in-depth, nuanced understanding of people’s experiences, knowledge and perspectives that are influenced by culture and society.

In order to develop a representative picture of a particular culture/ context, researchers must conduct extensive field work. 

This can be time-consuming as researchers may need to immerse themselves into a community/ culture for a few days, or possibly a few years.

Qualitative Data Analysis Methods

Different methods can be used for analyzing qualitative data. The researcher chooses based on the objectives of their study. 

The researcher plays a key role in the interpretation of data, making decisions about the coding, theming, decontextualizing, and recontextualizing of data (Starks & Trinidad, 2007). 

Grounded theory

Grounded theory is a qualitative method specifically designed to inductively generate theory from data. It was developed by Glaser and Strauss in 1967 (Glaser & Strauss, 2017).

 This methodology aims to develop theories (rather than test hypotheses) that explain a social process, action, or interaction (Petty et al., 2012). To inform the developing theory, data collection and analysis run simultaneously. 

There are three key types of coding used in grounded theory: initial (open), intermediate (axial), and advanced (selective) coding. 

Throughout the analysis, memos should be created to document methodological and theoretical ideas about the data. Data should be collected and analyzed until data saturation is reached and a theory is developed. 

Content analysis

Content analysis was first used in the early twentieth century to analyze textual materials such as newspapers and political speeches.

Content analysis is a research method used to identify and analyze the presence and patterns of themes, concepts, or words in data (Vaismoradi et al., 2013). 

This research method can be used to analyze data in different formats, which can be written, oral, or visual. 

The goal of content analysis is to develop themes that capture the underlying meanings of data (Schreier, 2012). 

Qualitative content analysis can be used to validate existing theories, support the development of new models and theories, and provide in-depth descriptions of particular settings or experiences.

The following six steps provide a guideline for how to conduct qualitative content analysis.

• Define a Research Question : To start content analysis, a clear research question should be developed.
• Identify and Collect Data : Establish the inclusion criteria for your data. Find the relevant sources to analyze.
• Define the Unit or Theme of Analysis : Categorize the content into themes. Themes can be a word, phrase, or sentence.
• Develop Rules for Coding your Data : Define a set of coding rules to ensure that all data are coded consistently.
• Code the Data : Follow the coding rules to categorize data into themes.
• Analyze the Results and Draw Conclusions : Examine the data to identify patterns and draw conclusions in relation to your research question.

Discourse analysis

Discourse analysis is a research method used to study written/ spoken language in relation to its social context (Wood & Kroger, 2000).

In discourse analysis, the researcher interprets details of language materials and the context in which it is situated.

Discourse analysis aims to understand the functions of language (how language is used in real life) and how meaning is conveyed by language in different contexts. Researchers use discourse analysis to investigate social groups and how language is used to achieve specific communication goals.

Different methods of discourse analysis can be used depending on the aims and objectives of a study. However, the following steps provide a guideline on how to conduct discourse analysis.

• Define the Research Question : Develop a relevant research question to frame the analysis.
• Gather Data and Establish the Context : Collect research materials (e.g., interview transcripts, documents). Gather factual details and review the literature to construct a theory about the social and historical context of your study.
• Analyze the Content : Closely examine various components of the text, such as the vocabulary, sentences, paragraphs, and structure of the text. Identify patterns relevant to the research question to create codes, then group these into themes.
• Review the Results : Reflect on the findings to examine the function of the language, and the meaning and context of the discourse. 

Thematic analysis

Thematic analysis is a method used to identify, interpret, and report patterns in data, such as commonalities or contrasts. 

Although the origin of thematic analysis can be traced back to the early twentieth century, understanding and clarity of thematic analysis is attributed to Braun and Clarke (2006).

Thematic analysis aims to develop themes (patterns of meaning) across a dataset to address a research question. 

In thematic analysis, qualitative data is gathered using techniques such as interviews, focus groups, and questionnaires. Audio recordings are transcribed. The dataset is then explored and interpreted by a researcher to identify patterns. 

This occurs through the rigorous process of data familiarisation, coding, theme development, and revision. These identified patterns provide a summary of the dataset and can be used to address a research question.

Themes are developed by exploring the implicit and explicit meanings within the data. Two different approaches are used to generate themes: inductive and deductive. 

An inductive approach allows themes to emerge from the data. In contrast, a deductive approach uses existing theories or knowledge to apply preconceived ideas to the data.

Phases of Thematic Analysis

Braun and Clarke (2006) provide a guide of the six phases of thematic analysis. These phases can be applied flexibly to fit research questions and data. 

Template analysis

Template analysis refers to a specific method of thematic analysis which uses hierarchical coding (Brooks et al., 2014).

Template analysis is used to analyze textual data, for example, interview transcripts or open-ended responses on a written questionnaire.

To conduct template analysis, a coding template must be developed (usually from a subset of the data) and subsequently revised and refined. This template represents the themes identified by researchers as important in the dataset. 

Codes are ordered hierarchically within the template, with the highest-level codes demonstrating overarching themes in the data and lower-level codes representing constituent themes with a narrower focus.

A guideline for the main procedural steps for conducting template analysis is outlined below.

• Familiarization with the Data : Read (and reread) the dataset in full. Engage, reflect, and take notes on data that may be relevant to the research question.
• Preliminary Coding : Identify initial codes using guidance from the a priori codes, identified before the analysis as likely to be beneficial and relevant to the analysis.
• Organize Themes : Organize themes into meaningful clusters. Consider the relationships between the themes both within and between clusters.
• Produce an Initial Template : Develop an initial template. This may be based on a subset of the data.
• Apply and Develop the Template : Apply the initial template to further data and make any necessary modifications. Refinements of the template may include adding themes, removing themes, or changing the scope/title of themes. 
• Finalize Template : Finalize the template, then apply it to the entire dataset. 

Frame analysis

Frame analysis is a comparative form of thematic analysis which systematically analyzes data using a matrix output.

Ritchie and Spencer (1994) developed this set of techniques to analyze qualitative data in applied policy research. Frame analysis aims to generate theory from data.

Frame analysis encourages researchers to organize and manage their data using summarization.

This results in a flexible and unique matrix output, in which individual participants (or cases) are represented by rows and themes are represented by columns. 

Each intersecting cell is used to summarize findings relating to the corresponding participant and theme.

Frame analysis has five distinct phases which are interrelated, forming a methodical and rigorous framework.

• Familiarization with the Data : Familiarize yourself with all the transcripts. Immerse yourself in the details of each transcript and start to note recurring themes.
• Develop a Theoretical Framework : Identify recurrent/ important themes and add them to a chart. Provide a framework/ structure for the analysis.
• Indexing : Apply the framework systematically to the entire study data.
• Summarize Data in Analytical Framework : Reduce the data into brief summaries of participants’ accounts.
• Mapping and Interpretation : Compare themes and subthemes and check against the original transcripts. Group the data into categories and provide an explanation for them.

Preventing Bias in Qualitative Research

To evaluate qualitative studies, the CASP (Critical Appraisal Skills Programme) checklist for qualitative studies can be used to ensure all aspects of a study have been considered (CASP, 2018).

The quality of research can be enhanced and assessed using criteria such as checklists, reflexivity, co-coding, and member-checking. 

Co-coding 

Relying on only one researcher to interpret rich and complex data may risk key insights and alternative viewpoints being missed. Therefore, coding is often performed by multiple researchers.

A common strategy must be defined at the beginning of the coding process  (Busetto et al., 2020). This includes establishing a useful coding list and finding a common definition of individual codes.

Transcripts are initially coded independently by researchers and then compared and consolidated to minimize error or bias and to bring confirmation of findings. 

Member checking

Member checking (or respondent validation) involves checking back with participants to see if the research resonates with their experiences (Russell & Gregory, 2003).

Data can be returned to participants after data collection or when results are first available. For example, participants may be provided with their interview transcript and asked to verify whether this is a complete and accurate representation of their views.

Participants may then clarify or elaborate on their responses to ensure they align with their views (Shenton, 2004).

This feedback becomes part of data collection and ensures accurate descriptions/ interpretations of phenomena (Mays & Pope, 2000). 

Reflexivity in qualitative research

Reflexivity typically involves examining your own judgments, practices, and belief systems during data collection and analysis. It aims to identify any personal beliefs which may affect the research. 

Reflexivity is essential in qualitative research to ensure methodological transparency and complete reporting. This enables readers to understand how the interaction between the researcher and participant shapes the data.

Depending on the research question and population being researched, factors that need to be considered include the experience of the researcher, how the contact was established and maintained, age, gender, and ethnicity.

These details are important because, in qualitative research, the researcher is a dynamic part of the research process and actively influences the outcome of the research (Boeije, 2014). 

Reflexivity Example

Who you are and your characteristics influence how you collect and analyze data. Here is an example of a reflexivity statement for research on smoking. I am a 30-year-old white female from a middle-class background. I live in the southwest of England and have been educated to master’s level. I have been involved in two research projects on oral health. I have never smoked, but I have witnessed how smoking can cause ill health from my volunteering in a smoking cessation clinic. My research aspirations are to help to develop interventions to help smokers quit.

Establishing Trustworthiness in Qualitative Research

Trustworthiness is a concept used to assess the quality and rigor of qualitative research. Four criteria are used to assess a study’s trustworthiness: credibility, transferability, dependability, and confirmability.

Credibility in Qualitative Research

Credibility refers to how accurately the results represent the reality and viewpoints of the participants.

To establish credibility in research, participants’ views and the researcher’s representation of their views need to align (Tobin & Begley, 2004).

To increase the credibility of findings, researchers may use data source triangulation, investigator triangulation, peer debriefing, or member checking (Lincoln & Guba, 1985). 

Transferability in Qualitative Research

Transferability refers to how generalizable the findings are: whether the findings may be applied to another context, setting, or group (Tobin & Begley, 2004).

Transferability can be enhanced by giving thorough and in-depth descriptions of the research setting, sample, and methods (Nowell et al., 2017). 

Dependability in Qualitative Research

Dependability is the extent to which the study could be replicated under similar conditions and the findings would be consistent.

Researchers can establish dependability using methods such as audit trails so readers can see the research process is logical and traceable (Koch, 1994).

Confirmability in Qualitative Research

Confirmability is concerned with establishing that there is a clear link between the researcher’s interpretations/ findings and the data.

Researchers can achieve confirmability by demonstrating how conclusions and interpretations were arrived at (Nowell et al., 2017).

This enables readers to understand the reasoning behind the decisions made. 

Audit Trails in Qualitative Research

An audit trail provides evidence of the decisions made by the researcher regarding theory, research design, and data collection, as well as the steps they have chosen to manage, analyze, and report data. 

The researcher must provide a clear rationale to demonstrate how conclusions were reached in their study.

A clear description of the research path must be provided to enable readers to trace through the researcher’s logic (Halpren, 1983).

Researchers should maintain records of the raw data, field notes, transcripts, and a reflective journal in order to provide a clear audit trail. 

Discovery of unexpected data

Open-ended questions in qualitative research mean the researcher can probe an interview topic and enable the participant to elaborate on responses in an unrestricted manner.

This allows unexpected data to emerge, which can lead to further research into that topic. 

Flexibility

Data collection and analysis can be modified and adapted to take the research in a different direction if new ideas or patterns emerge in the data.

This enables researchers to investigate new opportunities while firmly maintaining their research goals. 

Naturalistic settings

The behaviors of participants are recorded in real-world settings. Studies that use real-world settings have high ecological validity since participants behave more authentically. 

Limitations

Time-consuming .

Qualitative research results in large amounts of data which often need to be transcribed and analyzed manually.

Even when software is used, transcription can be inaccurate, and using software for analysis can result in many codes which need to be condensed into themes. 

Subjectivity 

The researcher has an integral role in collecting and interpreting qualitative data. Therefore, the conclusions reached are from their perspective and experience.

Consequently, interpretations of data from another researcher may vary greatly. 

Limited generalizability

The aim of qualitative research is to provide a detailed, contextualized understanding of an aspect of the human experience from a relatively small sample size.

Despite rigorous analysis procedures, conclusions drawn cannot be generalized to the wider population since data may be biased or unrepresentative.

Therefore, results are only applicable to a small group of the population. 

Extraneous variables

Qualitative research is often conducted in real-world settings. This may cause results to be unreliable since extraneous variables may affect the data, for example:

• Situational variables : different environmental conditions may influence participants’ behavior in a study. The random variation in factors (such as noise or lighting) may be difficult to control in real-world settings.
• Participant characteristics : this includes any characteristics that may influence how a participant answers/ behaves in a study. This may include a participant’s mood, gender, age, ethnicity, sexual identity, IQ, etc.
• Experimenter effect : experimenter effect refers to how a researcher’s unintentional influence can change the outcome of a study. This occurs when (i) their interactions with participants unintentionally change participants’ behaviors or (ii) due to errors in observation, interpretation, or analysis. 

What sample size should qualitative research be?

The sample size for qualitative studies has been recommended to include a minimum of 12 participants to reach data saturation (Braun, 2013).

Are surveys qualitative or quantitative?

Surveys can be used to gather information from a sample qualitatively or quantitatively. Qualitative surveys use open-ended questions to gather detailed information from a large sample using free text responses.

The use of open-ended questions allows for unrestricted responses where participants use their own words, enabling the collection of more in-depth information than closed-ended questions.

In contrast, quantitative surveys consist of closed-ended questions with multiple-choice answer options. Quantitative surveys are ideal to gather a statistical representation of a population.

What are the ethical considerations of qualitative research?

Before conducting a study, you must think about any risks that could occur and take steps to prevent them. Participant Protection : Researchers must protect participants from physical and mental harm. This means you must not embarrass, frighten, offend, or harm participants. Transparency : Researchers are obligated to clearly communicate how they will collect, store, analyze, use, and share the data. Confidentiality : You need to consider how to maintain the confidentiality and anonymity of participants’ data.

What is triangulation in qualitative research?

Triangulation refers to the use of several approaches in a study to comprehensively understand phenomena. This method helps to increase the validity and credibility of research findings. 

Types of triangulation include method triangulation (using multiple methods to gather data); investigator triangulation (multiple researchers for collecting/ analyzing data), theory triangulation (comparing several theoretical perspectives to explain a phenomenon), and data source triangulation (using data from various times, locations, and people; Carter et al., 2014).

Why is qualitative research important?

Qualitative research allows researchers to describe and explain the social world. The exploratory nature of qualitative research helps to generate hypotheses that can then be tested quantitatively.

In qualitative research, participants are able to express their thoughts, experiences, and feelings without constraint.

Additionally, researchers are able to follow up on participants’ answers in real-time, generating valuable discussion around a topic. This enables researchers to gain a nuanced understanding of phenomena which is difficult to attain using quantitative methods.

What is coding data in qualitative research?

Coding data is a qualitative data analysis strategy in which a section of text is assigned with a label that describes its content.

These labels may be words or phrases which represent important (and recurring) patterns in the data.

This process enables researchers to identify related content across the dataset. Codes can then be used to group similar types of data to generate themes.

What is the difference between qualitative and quantitative research?

Qualitative research involves the collection and analysis of non-numerical data in order to understand experiences and meanings from the participant’s perspective.

This can provide rich, in-depth insights on complicated phenomena. Qualitative data may be collected using interviews, focus groups, or observations.

In contrast, quantitative research involves the collection and analysis of numerical data to measure the frequency, magnitude, or relationships of variables. This can provide objective and reliable evidence that can be generalized to the wider population.

Quantitative data may be collected using closed-ended questionnaires or experiments.

What is trustworthiness in qualitative research?

Trustworthiness is a concept used to assess the quality and rigor of qualitative research. Four criteria are used to assess a study’s trustworthiness: credibility, transferability, dependability, and confirmability. 

Credibility refers to how accurately the results represent the reality and viewpoints of the participants. Transferability refers to whether the findings may be applied to another context, setting, or group.

Dependability is the extent to which the findings are consistent and reliable. Confirmability refers to the objectivity of findings (not influenced by the bias or assumptions of researchers).

What is data saturation in qualitative research?

Data saturation is a methodological principle used to guide the sample size of a qualitative research study.

Data saturation is proposed as a necessary methodological component in qualitative research (Saunders et al., 2018) as it is a vital criterion for discontinuing data collection and/or analysis. 

The intention of data saturation is to find “no new data, no new themes, no new coding, and ability to replicate the study” (Guest et al., 2006). Therefore, enough data has been gathered to make conclusions.

Why is sampling in qualitative research important?

In quantitative research, large sample sizes are used to provide statistically significant quantitative estimates.

This is because quantitative research aims to provide generalizable conclusions that represent populations.

However, the aim of sampling in qualitative research is to gather data that will help the researcher understand the depth, complexity, variation, or context of a phenomenon. The small sample sizes in qualitative studies support the depth of case-oriented analysis.

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How to Recruit Participants for Qualitative Research (2022 Edition)

We explain best practices for recruiting participants for qualitative research that will help you save time and money.

Qualitative research, when executed correctly, explores and uncovers the emotional and cognitive motivations behind your target audience’s actions, behaviors, and opinions relative to your research objectives and goals. 

So, the success of a qualitative research project depends on engaging the “right” participants—highly qualified, fitting the profile, enthusiastic and articulate. But research participant recruitment can be a resource “suck”, devouring time and money that could be used for the actual research, analysis and report writing. Let’s explore how to recruit the best, most qualified participants while saving both time and money.

6 Steps to Recruiting Quality Participants

From defining the objectives of your project to clarifying the factors and qualities of the participants you’ll need to meet those objectives, to creating the questions for the initial screening survey and follow up conversational screener that will identify qualified participants to setting a motivating incentive, the steps to a successful qualitative research project can be a lot. Let’s break it all down. 

1. Hold a Stakeholder Meeting to Define Research Objectives

Before you begin the process to recruit participants for qualitative research , you need to define precisely what you're trying to achieve with the research. This information will be useful when crafting your screener questions, securing participants that fit the profile and even setting the incentive amount. 

If you collaborate with other teams on a research project, the critical first step is to hold a stakeholders’ meeting to determine research objectives and ensure all stakeholders agree on those objectives.

Asking the questions that concisely define the purpose of your research project will also provide the parameters for exactly who the study should focus on. This will become your participant profile.

5 Sample Questions for a Stakeholder’s Meeting

• What’s the objective of this project e.g., what do you want to learn?
• What audience has the demographics, background, education, experience, skill, information you need to meet those objectives?
• What do you already know in relation to the objectives?
• How will your organization use the results of the research/What will your organization do with the learnings?
• What are your concerns, if any, regarding this project? How will those concerns be met and managed?

Once you have the answers to these questions, you can move on to the next step. 

2. Develop and Fine Tune Screener Survey Questions 

Your screener survey allows you to cull potential participants quickly. This means the most important criteria for qualification/disqualification need to be at the beginning of the survey—both your non-negotiables (immediate disqualifiers) and your negotiables (subject-to-approval and/or less rigid disqualifiers). 

In most cases, non-negotiables are concrete questions related to demographics, such as a candidate’s business, location, age, gender, ethnicity and past research participation. However, screening questions can also be identifying behaviors and/or opinions. For example, if you're looking for marketing professionals that use a specific type of software, use of this software and even use of this software over a specified amount of time might be a must to qualify.

Leading questions with transparent choices for response should be avoided. This can be achieved by offering some options in multiple-choice response lists that will mis-direct unqualified potential participants. 

3. Assess For Articulateness and Enthusiasm in the Conversational Screen

When conducting a qualitative study, you are exploring the motivations behind behaviors and opinions . For example, if you're testing a website, you’re learning about participants’ journeys through the site and striving to understand what exactly drove their navigation choices. 

Participants that are articulate and outgoing enough to examine and explain the logical process and emotional triggers that caused them to choose one path over the other are a must. 

Finding these participants is one of the greatest challenges of a successful recruitment. Asking “Articulation Questions” that require time, thought and putting feelings into words, will help identify these participants. 

Sample Articulation Questions 

• Think about the last book you read. Describe it and how it made you feel. 
• What is your thought process when you go shopping for groceries? How does that differ for different types of foods?
• Describe the next vacation you want to take and why you want to go there. 

Note that Articulation Questions in no way relate to the research topic. They are questions anyone can answer and will determine whether a candidate is more likely to answer with thought, in detail and openly sharing emotions versus only responding with the bare minimum.

4. Consider Using Advanced Screening 

Speak directly with candidates : At  Respondent , we provide the ability to conduct unique and advanced screening. One feature allows you to speak directly with candidates. Speaking directly with candidates will help determine if a candidate can elaborate in their answers and offer the detail needed.

Avoid imposters : Because of the incentives offered for research participation, there are people who attempt to participate in any and all research projects whether they qualify or not. Some will create fake email accounts and lie in their screener responses to qualify. Having one of these imposters slip through and take the place of a qualified participant can skew research results. Respondent pre-vets candidates through their social media accounts and the requirement of having a valid business email. This guards against any posers slipping through. 

Participant Ratings : Another Respondent safeguard encourages researchers to rate participants. After a study, a survey is sent out to rate the effectiveness of each of your participants as:  

• Poor (did not meet expectations) 
• Good (met expectations) 
• Great (exceeded expectations)

For Respondent researchers, participant rating is a unique and an important element in the recruiting process. 

5. The Importance of Over-Recruiting

No matter how diligent you are in your recruiting, there will likely be no-shows. So, it's a good idea to always over-recruit. 

For focus groups it’s common practice to recruit two additional participants per group e.g., recruit 10 to seat 8 per group. If 9 or even 10 show up, it’s up to the moderator and client if all participants will be included in the focus group or not. Keep in mind that all participants who show up, whether they are asked to participate or not must be paid their incentive. 

For I-D-Is (one-on-one interviews), recruit several back-up participants that can be contacted and scheduled to replace any no-shows. Again, it’s up to the moderator and client if all who have been recruited will be interviewed or not. 

Respondent makes no-show and replacement management easy. If you have an I-D-I participant that doesn't show up, mark them as "no-show." Respondent will immediately contact you, asking if you want us to identify a replacement from your previously vetted participant pool. The replacement participant will be scheduled as a make up for your no-show. Respondent will not charge for the recruiting of no-shows.

6. Offer Fair & Quick Compensation 

Determining what type and the amount of the incentive for participants can be a challenge.  The amount needs to be motivating for participants to first agree to participate and then to actually show-up. The amount offered must also fit within the research budget. This can be a balancing act. 

Typically, the longer a participant is needed, the larger your incentive needs to be. Additionally, the location of the study must be considered. Higher compensation will be necessary for an in-person study versus a remote one. 

Individuals in certain professions and at higher income levels will not be as motivated by an incentive. Larger incentives must be offered to these participants for both a timely and successful recruit and to encourage their attendance.

Respondent handles the payment of participant incentives which can be a hassle and time-consuming. Simply indicate that a participant has shown up and participated and Respondent takes care of payment. 

Recruiting Made Quick and Easy with Respondent

Following the steps to have a successful recruit which leads to a successful project traditionally has been difficult, time consuming and costly. Respondent offers solutions that streamlines and accelerates the process while providing the highest quality participants you can be confident in and all this at reasonable costs. Give Respondent a try.

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Home » Qualitative Research – Methods, Analysis Types and Guide

Qualitative Research – Methods, Analysis Types and Guide

Table of Contents

Qualitative Research

Qualitative research is a type of research methodology that focuses on exploring and understanding people’s beliefs, attitudes, behaviors, and experiences through the collection and analysis of non-numerical data. It seeks to answer research questions through the examination of subjective data, such as interviews, focus groups, observations, and textual analysis.

Qualitative research aims to uncover the meaning and significance of social phenomena, and it typically involves a more flexible and iterative approach to data collection and analysis compared to quantitative research. Qualitative research is often used in fields such as sociology, anthropology, psychology, and education.

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

This method involves conducting an interview with a single participant to gain a detailed understanding of their experiences, attitudes, and beliefs. One-to-one interviews can be conducted in-person, over the phone, or through video conferencing. The interviewer typically uses open-ended questions to encourage the participant to share their thoughts and feelings. One-to-one interviews are useful for gaining detailed insights into individual experiences.

Focus Groups

This method involves bringing together a group of people to discuss a specific topic in a structured setting. The focus group is led by a moderator who guides the discussion and encourages participants to share their thoughts and opinions. Focus groups are useful for generating ideas and insights, exploring social norms and attitudes, and understanding group dynamics.

Ethnographic Studies

This method involves immersing oneself in a culture or community to gain a deep understanding of its norms, beliefs, and practices. Ethnographic studies typically involve long-term fieldwork and observation, as well as interviews and document analysis. Ethnographic studies are useful for understanding the cultural context of social phenomena and for gaining a holistic understanding of complex social processes.

Text Analysis

This method involves analyzing written or spoken language to identify patterns and themes. Text analysis can be quantitative or qualitative. Qualitative text analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Text analysis is useful for understanding media messages, public discourse, and cultural trends.

This method involves an in-depth examination of a single person, group, or event to gain an understanding of complex phenomena. Case studies typically involve a combination of data collection methods, such as interviews, observations, and document analysis, to provide a comprehensive understanding of the case. Case studies are useful for exploring unique or rare cases, and for generating hypotheses for further research.

Process of Observation

This method involves systematically observing and recording behaviors and interactions in natural settings. The observer may take notes, use audio or video recordings, or use other methods to document what they see. Process of observation is useful for understanding social interactions, cultural practices, and the context in which behaviors occur.

Record Keeping

This method involves keeping detailed records of observations, interviews, and other data collected during the research process. Record keeping is essential for ensuring the accuracy and reliability of the data, and for providing a basis for analysis and interpretation.

This method involves collecting data from a large sample of participants through a structured questionnaire. Surveys can be conducted in person, over the phone, through mail, or online. Surveys are useful for collecting data on attitudes, beliefs, and behaviors, and for identifying patterns and trends in a population.

Qualitative data analysis is a process of turning unstructured data into meaningful insights. It involves extracting and organizing information from sources like interviews, focus groups, and surveys. The goal is to understand people’s attitudes, behaviors, and motivations

Qualitative Research Analysis Methods

Qualitative Research analysis methods involve a systematic approach to interpreting and making sense of the data collected in qualitative research. Here are some common qualitative data analysis methods:

Thematic Analysis

This method involves identifying patterns or themes in the data that are relevant to the research question. The researcher reviews the data, identifies keywords or phrases, and groups them into categories or themes. Thematic analysis is useful for identifying patterns across multiple data sources and for generating new insights into the research topic.

Content Analysis

This method involves analyzing the content of written or spoken language to identify key themes or concepts. Content analysis can be quantitative or qualitative. Qualitative content analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Content analysis is useful for identifying patterns in media messages, public discourse, and cultural trends.

Discourse Analysis

This method involves analyzing language to understand how it constructs meaning and shapes social interactions. Discourse analysis can involve a variety of methods, such as conversation analysis, critical discourse analysis, and narrative analysis. Discourse analysis is useful for understanding how language shapes social interactions, cultural norms, and power relationships.

Grounded Theory Analysis

This method involves developing a theory or explanation based on the data collected. Grounded theory analysis starts with the data and uses an iterative process of coding and analysis to identify patterns and themes in the data. The theory or explanation that emerges is grounded in the data, rather than preconceived hypotheses. Grounded theory analysis is useful for understanding complex social phenomena and for generating new theoretical insights.

Narrative Analysis

This method involves analyzing the stories or narratives that participants share to gain insights into their experiences, attitudes, and beliefs. Narrative analysis can involve a variety of methods, such as structural analysis, thematic analysis, and discourse analysis. Narrative analysis is useful for understanding how individuals construct their identities, make sense of their experiences, and communicate their values and beliefs.

Phenomenological Analysis

This method involves analyzing how individuals make sense of their experiences and the meanings they attach to them. Phenomenological analysis typically involves in-depth interviews with participants to explore their experiences in detail. Phenomenological analysis is useful for understanding subjective experiences and for developing a rich understanding of human consciousness.

Comparative Analysis

This method involves comparing and contrasting data across different cases or groups to identify similarities and differences. Comparative analysis can be used to identify patterns or themes that are common across multiple cases, as well as to identify unique or distinctive features of individual cases. Comparative analysis is useful for understanding how social phenomena vary across different contexts and groups.

Applications of Qualitative Research

Qualitative research has many applications across different fields and industries. Here are some examples of how qualitative research is used:

• Market Research: Qualitative research is often used in market research to understand consumer attitudes, behaviors, and preferences. Researchers conduct focus groups and one-on-one interviews with consumers to gather insights into their experiences and perceptions of products and services.
• Health Care: Qualitative research is used in health care to explore patient experiences and perspectives on health and illness. Researchers conduct in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education: Qualitative research is used in education to understand student experiences and to develop effective teaching strategies. Researchers conduct classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work : Qualitative research is used in social work to explore social problems and to develop interventions to address them. Researchers conduct in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : Qualitative research is used in anthropology to understand different cultures and societies. Researchers conduct ethnographic studies and observe and interview members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : Qualitative research is used in psychology to understand human behavior and mental processes. Researchers conduct in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy : Qualitative research is used in public policy to explore public attitudes and to inform policy decisions. Researchers conduct focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

• Identify your research question: Qualitative research starts with a research question or set of questions that you want to explore. This question should be focused and specific, but also broad enough to allow for exploration and discovery.
• Select your research design: There are different types of qualitative research designs, including ethnography, case study, grounded theory, and phenomenology. You should select a design that aligns with your research question and that will allow you to gather the data you need to answer your research question.
• Recruit participants: Once you have your research question and design, you need to recruit participants. The number of participants you need will depend on your research design and the scope of your research. You can recruit participants through advertisements, social media, or through personal networks.
• Collect data: There are different methods for collecting qualitative data, including interviews, focus groups, observation, and document analysis. You should select the method or methods that align with your research design and that will allow you to gather the data you need to answer your research question.
• Analyze data: Once you have collected your data, you need to analyze it. This involves reviewing your data, identifying patterns and themes, and developing codes to organize your data. You can use different software programs to help you analyze your data, or you can do it manually.
• Interpret data: Once you have analyzed your data, you need to interpret it. This involves making sense of the patterns and themes you have identified, and developing insights and conclusions that answer your research question. You should be guided by your research question and use your data to support your conclusions.
• Communicate results: Once you have interpreted your data, you need to communicate your results. This can be done through academic papers, presentations, or reports. You should be clear and concise in your communication, and use examples and quotes from your data to support your findings.

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

• Customer Feedback: A company may conduct qualitative research to understand the feedback and experiences of its customers. This may involve conducting focus groups or one-on-one interviews with customers to gather insights into their attitudes, behaviors, and preferences.
• Healthcare : A healthcare provider may conduct qualitative research to explore patient experiences and perspectives on health and illness. This may involve conducting in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education : An educational institution may conduct qualitative research to understand student experiences and to develop effective teaching strategies. This may involve conducting classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work: A social worker may conduct qualitative research to explore social problems and to develop interventions to address them. This may involve conducting in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : An anthropologist may conduct qualitative research to understand different cultures and societies. This may involve conducting ethnographic studies and observing and interviewing members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : A psychologist may conduct qualitative research to understand human behavior and mental processes. This may involve conducting in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy: A government agency or non-profit organization may conduct qualitative research to explore public attitudes and to inform policy decisions. This may involve conducting focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

Purpose of Qualitative Research

The purpose of qualitative research is to explore and understand the subjective experiences, behaviors, and perspectives of individuals or groups in a particular context. Unlike quantitative research, which focuses on numerical data and statistical analysis, qualitative research aims to provide in-depth, descriptive information that can help researchers develop insights and theories about complex social phenomena.

Qualitative research can serve multiple purposes, including:

• Exploring new or emerging phenomena : Qualitative research can be useful for exploring new or emerging phenomena, such as new technologies or social trends. This type of research can help researchers develop a deeper understanding of these phenomena and identify potential areas for further study.
• Understanding complex social phenomena : Qualitative research can be useful for exploring complex social phenomena, such as cultural beliefs, social norms, or political processes. This type of research can help researchers develop a more nuanced understanding of these phenomena and identify factors that may influence them.
• Generating new theories or hypotheses: Qualitative research can be useful for generating new theories or hypotheses about social phenomena. By gathering rich, detailed data about individuals’ experiences and perspectives, researchers can develop insights that may challenge existing theories or lead to new lines of inquiry.
• Providing context for quantitative data: Qualitative research can be useful for providing context for quantitative data. By gathering qualitative data alongside quantitative data, researchers can develop a more complete understanding of complex social phenomena and identify potential explanations for quantitative findings.

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

• Exploring a new area: If little is known about a particular topic, qualitative research can help to identify key issues, generate hypotheses, and develop new theories.
• Understanding complex phenomena: Qualitative research can be used to investigate complex social, cultural, or organizational phenomena that are difficult to measure quantitatively.
• Investigating subjective experiences: Qualitative research is particularly useful for investigating the subjective experiences of individuals or groups, such as their attitudes, beliefs, values, or emotions.
• Conducting formative research: Qualitative research can be used in the early stages of a research project to develop research questions, identify potential research participants, and refine research methods.
• Evaluating interventions or programs: Qualitative research can be used to evaluate the effectiveness of interventions or programs by collecting data on participants’ experiences, attitudes, and behaviors.

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

• Focus on subjective experience: Qualitative research is concerned with understanding the subjective experiences, beliefs, and perspectives of individuals or groups in a particular context. Researchers aim to explore the meanings that people attach to their experiences and to understand the social and cultural factors that shape these meanings.
• Use of open-ended questions: Qualitative research relies on open-ended questions that allow participants to provide detailed, in-depth responses. Researchers seek to elicit rich, descriptive data that can provide insights into participants’ experiences and perspectives.
• Sampling-based on purpose and diversity: Qualitative research often involves purposive sampling, in which participants are selected based on specific criteria related to the research question. Researchers may also seek to include participants with diverse experiences and perspectives to capture a range of viewpoints.
• Data collection through multiple methods: Qualitative research typically involves the use of multiple data collection methods, such as in-depth interviews, focus groups, and observation. This allows researchers to gather rich, detailed data from multiple sources, which can provide a more complete picture of participants’ experiences and perspectives.
• Inductive data analysis: Qualitative research relies on inductive data analysis, in which researchers develop theories and insights based on the data rather than testing pre-existing hypotheses. Researchers use coding and thematic analysis to identify patterns and themes in the data and to develop theories and explanations based on these patterns.
• Emphasis on researcher reflexivity: Qualitative research recognizes the importance of the researcher’s role in shaping the research process and outcomes. Researchers are encouraged to reflect on their own biases and assumptions and to be transparent about their role in the research process.

Advantages of Qualitative Research

Qualitative research offers several advantages over other research methods, including:

• Depth and detail: Qualitative research allows researchers to gather rich, detailed data that provides a deeper understanding of complex social phenomena. Through in-depth interviews, focus groups, and observation, researchers can gather detailed information about participants’ experiences and perspectives that may be missed by other research methods.
• Flexibility : Qualitative research is a flexible approach that allows researchers to adapt their methods to the research question and context. Researchers can adjust their research methods in real-time to gather more information or explore unexpected findings.
• Contextual understanding: Qualitative research is well-suited to exploring the social and cultural context in which individuals or groups are situated. Researchers can gather information about cultural norms, social structures, and historical events that may influence participants’ experiences and perspectives.
• Participant perspective : Qualitative research prioritizes the perspective of participants, allowing researchers to explore subjective experiences and understand the meanings that participants attach to their experiences.
• Theory development: Qualitative research can contribute to the development of new theories and insights about complex social phenomena. By gathering rich, detailed data and using inductive data analysis, researchers can develop new theories and explanations that may challenge existing understandings.
• Validity : Qualitative research can offer high validity by using multiple data collection methods, purposive and diverse sampling, and researcher reflexivity. This can help ensure that findings are credible and trustworthy.

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

• Subjectivity : Qualitative research relies on the subjective interpretation of researchers, which can introduce bias into the research process. The researcher’s perspective, beliefs, and experiences can influence the way data is collected, analyzed, and interpreted.
• Limited generalizability: Qualitative research typically involves small, purposive samples that may not be representative of larger populations. This limits the generalizability of findings to other contexts or populations.
• Time-consuming: Qualitative research can be a time-consuming process, requiring significant resources for data collection, analysis, and interpretation.
• Resource-intensive: Qualitative research may require more resources than other research methods, including specialized training for researchers, specialized software for data analysis, and transcription services.
• Limited reliability: Qualitative research may be less reliable than quantitative research, as it relies on the subjective interpretation of researchers. This can make it difficult to replicate findings or compare results across different studies.
• Ethics and confidentiality: Qualitative research involves collecting sensitive information from participants, which raises ethical concerns about confidentiality and informed consent. Researchers must take care to protect the privacy and confidentiality of participants and obtain informed consent.

Also see Research Methods

About the author

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Researcher, Academic Writer, Web developer

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Sampling Techniques for Qualitative Research

• First Online: 27 October 2022

Cite this chapter

• Heather Douglas 4  

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This chapter explains how to design suitable sampling strategies for qualitative research. The focus of this chapter is purposive (or theoretical) sampling to produce credible and trustworthy explanations of a phenomenon (a specific aspect of society). A specific research question (RQ) guides the methodology (the study design or approach ). It defines the participants, location, and actions to be used to answer the question. Qualitative studies use specific tools and techniques ( methods ) to sample people, organizations, or whatever is to be examined. The methodology guides the selection of tools and techniques for sampling, data analysis, quality assurance, etc. These all vary according to the purpose and design of the study and the RQ. In this chapter, a fake example is used to demonstrate how to apply your sampling strategy in a developing country.

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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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Interviews in the social sciences

Professionalism in dentistry: deconstructing common terminology

A review of technical and quality assessment considerations of audio-visual and web-conferencing focus groups in qualitative health research, 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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Accepted : 02 July 2018

Published : 05 October 2018

Issue Date : 12 October 2018

DOI : https://doi.org/10.1038/sj.bdj.2018.815

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18 Qualitative Research Examples

Qualitative research is an approach to scientific research that involves using observation to gather and analyze non-numerical, in-depth, and well-contextualized datasets.

It serves as an integral part of academic, professional, and even daily decision-making processes (Baxter & Jack, 2008).

Methods of qualitative research encompass a wide range of techniques, from in-depth personal encounters, like ethnographies (studying cultures in-depth) and autoethnographies (examining one’s own cultural experiences), to collection of diverse perspectives on topics through methods like interviewing focus groups (gatherings of individuals to discuss specific topics).

Qualitative Research Examples

1. ethnography.

Definition: Ethnography is a qualitative research design aimed at exploring cultural phenomena. Rooted in the discipline of anthropology , this research approach investigates the social interactions, behaviors, and perceptions within groups, communities, or organizations.

Ethnographic research is characterized by extended observation of the group, often through direct participation, in the participants’ environment. An ethnographer typically lives with the study group for extended periods, intricately observing their everyday lives (Khan, 2014).

It aims to present a complete, detailed and accurate picture of the observed social life, rituals, symbols, and values from the perspective of the study group.

Example of Ethnographic Research

Title: “ The Everyday Lives of Men: An Ethnographic Investigation of Young Adult Male Identity “

Citation: Evans, J. (2010). The Everyday Lives of Men: An Ethnographic Investigation of Young Adult Male Identity. Peter Lang.

Overview: This study by Evans (2010) provides a rich narrative of young adult male identity as experienced in everyday life. The author immersed himself among a group of young men, participating in their activities and cultivating a deep understanding of their lifestyle, values, and motivations. This research exemplified the ethnographic approach, revealing complexities of the subjects’ identities and societal roles, which could hardly be accessed through other qualitative research designs.

Read my Full Guide on Ethnography Here

2. Autoethnography

Definition: Autoethnography is an approach to qualitative research where the researcher uses their own personal experiences to extend the understanding of a certain group, culture, or setting. Essentially, it allows for the exploration of self within the context of social phenomena.

Unlike traditional ethnography, which focuses on the study of others, autoethnography turns the ethnographic gaze inward, allowing the researcher to use their personal experiences within a culture as rich qualitative data (Durham, 2019).

The objective is to critically appraise one’s personal experiences as they navigate and negotiate cultural, political, and social meanings. The researcher becomes both the observer and the participant, intertwining personal and cultural experiences in the research.

Example of Autoethnographic Research

Title: “ A Day In The Life Of An NHS Nurse “

Citation: Osben, J. (2019). A day in the life of a NHS nurse in 21st Century Britain: An auto-ethnography. The Journal of Autoethnography for Health & Social Care. 1(1).

Overview: This study presents an autoethnography of a day in the life of an NHS nurse (who, of course, is also the researcher). The author uses the research to achieve reflexivity, with the researcher concluding: “Scrutinising my practice and situating it within a wider contextual backdrop has compelled me to significantly increase my level of scrutiny into the driving forces that influence my practice.”

Read my Full Guide on Autoethnography Here

3. Semi-Structured Interviews

Definition: Semi-structured interviews stand as one of the most frequently used methods in qualitative research. These interviews are planned and utilize a set of pre-established questions, but also allow for the interviewer to steer the conversation in other directions based on the responses given by the interviewee.

In semi-structured interviews, the interviewer prepares a guide that outlines the focal points of the discussion. However, the interview is flexible, allowing for more in-depth probing if the interviewer deems it necessary (Qu, & Dumay, 2011). This style of interviewing strikes a balance between structured ones which might limit the discussion, and unstructured ones, which could lack focus.

Example of Semi-Structured Interview Research

Title: “ Factors influencing adherence to cancer treatment in older adults with cancer: a systematic review “

Citation: Puts, M., et al. (2014). Factors influencing adherence to cancer treatment in older adults with cancer: a systematic review. Annals of oncology, 25 (3), 564-577.

Overview: Puts et al. (2014) executed an extensive systematic review in which they conducted semi-structured interviews with older adults suffering from cancer to examine the factors influencing their adherence to cancer treatment. The findings suggested that various factors, including side effects, faith in healthcare professionals, and social support have substantial impacts on treatment adherence. This research demonstrates how semi-structured interviews can provide rich and profound insights into the subjective experiences of patients.

4. Focus Groups

Definition: Focus groups are a qualitative research method that involves organized discussion with a selected group of individuals to gain their perspectives on a specific concept, product, or phenomenon. Typically, these discussions are guided by a moderator.

During a focus group session, the moderator has a list of questions or topics to discuss, and participants are encouraged to interact with each other (Morgan, 2010). This interactivity can stimulate more information and provide a broader understanding of the issue under scrutiny. The open format allows participants to ask questions and respond freely, offering invaluable insights into attitudes, experiences, and group norms.

Example of Focus Group Research

Title: “ Perspectives of Older Adults on Aging Well: A Focus Group Study “

Citation: Halaweh, H., Dahlin-Ivanoff, S., Svantesson, U., & Willén, C. (2018). Perspectives of older adults on aging well: a focus group study. Journal of aging research .

Overview: This study aimed to explore what older adults (aged 60 years and older) perceived to be ‘aging well’. The researchers identified three major themes from their focus group interviews: a sense of well-being, having good physical health, and preserving good mental health. The findings highlight the importance of factors such as positive emotions, social engagement, physical activity, healthy eating habits, and maintaining independence in promoting aging well among older adults.

5. Phenomenology

Definition: Phenomenology, a qualitative research method, involves the examination of lived experiences to gain an in-depth understanding of the essence or underlying meanings of a phenomenon.

The focus of phenomenology lies in meticulously describing participants’ conscious experiences related to the chosen phenomenon (Padilla-Díaz, 2015).

In a phenomenological study, the researcher collects detailed, first-hand perspectives of the participants, typically via in-depth interviews, and then uses various strategies to interpret and structure these experiences, ultimately revealing essential themes (Creswell, 2013). This approach focuses on the perspective of individuals experiencing the phenomenon, seeking to explore, clarify, and understand the meanings they attach to those experiences.

Example of Phenomenology Research

Title: “ A phenomenological approach to experiences with technology: current state, promise, and future directions for research ”

Citation: Cilesiz, S. (2011). A phenomenological approach to experiences with technology: Current state, promise, and future directions for research. Educational Technology Research and Development, 59 , 487-510.

Overview: A phenomenological approach to experiences with technology by Sebnem Cilesiz represents a good starting point for formulating a phenomenological study. With its focus on the ‘essence of experience’, this piece presents methodological, reliability, validity, and data analysis techniques that phenomenologists use to explain how people experience technology in their everyday lives.

6. Grounded Theory

Definition: Grounded theory is a systematic methodology in qualitative research that typically applies inductive reasoning . The primary aim is to develop a theoretical explanation or framework for a process, action, or interaction grounded in, and arising from, empirical data (Birks & Mills, 2015).

In grounded theory, data collection and analysis work together in a recursive process. The researcher collects data, analyses it, and then collects more data based on the evolving understanding of the research context. This ongoing process continues until a comprehensive theory that represents the data and the associated phenomenon emerges – a point known as theoretical saturation (Charmaz, 2014).

Example of Grounded Theory Research

Title: “ Student Engagement in High School Classrooms from the Perspective of Flow Theory “

Citation: Shernoff, D. J., Csikszentmihalyi, M., Shneider, B., & Shernoff, E. S. (2003). Student engagement in high school classrooms from the perspective of flow theory. School Psychology Quarterly, 18 (2), 158–176.

Overview: Shernoff and colleagues (2003) used grounded theory to explore student engagement in high school classrooms. The researchers collected data through student self-reports, interviews, and observations. Key findings revealed that academic challenge, student autonomy, and teacher support emerged as the most significant factors influencing students’ engagement, demonstrating how grounded theory can illuminate complex dynamics within real-world contexts.

7. Narrative Research

Definition: Narrative research is a qualitative research method dedicated to storytelling and understanding how individuals experience the world. It focuses on studying an individual’s life and experiences as narrated by that individual (Polkinghorne, 2013).

In narrative research, the researcher collects data through methods such as interviews, observations , and document analysis. The emphasis is on the stories told by participants – narratives that reflect their experiences, thoughts, and feelings.

These stories are then interpreted by the researcher, who attempts to understand the meaning the participant attributes to these experiences (Josselson, 2011).

Example of Narrative Research

Title: “Narrative Structures and the Language of the Self”

Citation: McAdams, D. P., Josselson, R., & Lieblich, A. (2006). Identity and story: Creating self in narrative . American Psychological Association.

Overview: In this innovative study, McAdams et al. (2006) employed narrative research to explore how individuals construct their identities through the stories they tell about themselves. By examining personal narratives, the researchers discerned patterns associated with characters, motivations, conflicts, and resolutions, contributing valuable insights about the relationship between narrative and individual identity.

8. Case Study Research

Definition: Case study research is a qualitative research method that involves an in-depth investigation of a single instance or event: a case. These ‘cases’ can range from individuals, groups, or entities to specific projects, programs, or strategies (Creswell, 2013).

The case study method typically uses multiple sources of information for comprehensive contextual analysis. It aims to explore and understand the complexity and uniqueness of a particular case in a real-world context (Merriam & Tisdell, 2015). This investigation could result in a detailed description of the case, a process for its development, or an exploration of a related issue or problem.

Example of Case Study Research

Title: “ Teacher’s Role in Fostering Preschoolers’ Computational Thinking: An Exploratory Case Study “

Citation: Wang, X. C., Choi, Y., Benson, K., Eggleston, C., & Weber, D. (2021). Teacher’s role in fostering preschoolers’ computational thinking: An exploratory case study. Early Education and Development , 32 (1), 26-48.

Overview: This study investigates the role of teachers in promoting computational thinking skills in preschoolers. The study utilized a qualitative case study methodology to examine the computational thinking scaffolding strategies employed by a teacher interacting with three preschoolers in a small group setting. The findings highlight the importance of teachers’ guidance in fostering computational thinking practices such as problem reformulation/decomposition, systematic testing, and debugging.

Read about some Famous Case Studies in Psychology Here

9. Participant Observation

Definition: Participant observation has the researcher immerse themselves in a group or community setting to observe the behavior of its members. It is similar to ethnography, but generally, the researcher isn’t embedded for a long period of time.

The researcher, being a participant, engages in daily activities, interactions, and events as a way of conducting a detailed study of a particular social phenomenon (Kawulich, 2005).

The method involves long-term engagement in the field, maintaining detailed records of observed events, informal interviews, direct participation, and reflexivity. This approach allows for a holistic view of the participants’ lived experiences, behaviours, and interactions within their everyday environment (Dewalt, 2011).

Example of Participant Observation Research

Title: Conflict in the boardroom: a participant observation study of supervisory board dynamics

Citation: Heemskerk, E. M., Heemskerk, K., & Wats, M. M. (2017). Conflict in the boardroom: a participant observation study of supervisory board dynamics. Journal of Management & Governance , 21 , 233-263.

Overview: This study examined how conflicts within corporate boards affect their performance. The researchers used a participant observation method, where they actively engaged with 11 supervisory boards and observed their dynamics. They found that having a shared understanding of the board’s role called a common framework, improved performance by reducing relationship conflicts, encouraging task conflicts, and minimizing conflicts between the board and CEO.

10. Non-Participant Observation

Definition: Non-participant observation is a qualitative research method in which the researcher observes the phenomena of interest without actively participating in the situation, setting, or community being studied.

This method allows the researcher to maintain a position of distance, as they are solely an observer and not a participant in the activities being observed (Kawulich, 2005).

During non-participant observation, the researcher typically records field notes on the actions, interactions, and behaviors observed , focusing on specific aspects of the situation deemed relevant to the research question.

This could include verbal and nonverbal communication , activities, interactions, and environmental contexts (Angrosino, 2007). They could also use video or audio recordings or other methods to collect data.

Example of Non-Participant Observation Research

Title: Mental Health Nurses’ attitudes towards mental illness and recovery-oriented practice in acute inpatient psychiatric units: A non-participant observation study

Citation: Sreeram, A., Cross, W. M., & Townsin, L. (2023). Mental Health Nurses’ attitudes towards mental illness and recovery‐oriented practice in acute inpatient psychiatric units: A non‐participant observation study. International Journal of Mental Health Nursing .

Overview: This study investigated the attitudes of mental health nurses towards mental illness and recovery-oriented practice in acute inpatient psychiatric units. The researchers used a non-participant observation method, meaning they observed the nurses without directly participating in their activities. The findings shed light on the nurses’ perspectives and behaviors, providing valuable insights into their attitudes toward mental health and recovery-focused care in these settings.

11. Content Analysis

Definition: Content Analysis involves scrutinizing textual, visual, or spoken content to categorize and quantify information. The goal is to identify patterns, themes, biases, or other characteristics (Hsieh & Shannon, 2005).

Content Analysis is widely used in various disciplines for a multitude of purposes. Researchers typically use this method to distill large amounts of unstructured data, like interview transcripts, newspaper articles, or social media posts, into manageable and meaningful chunks.

When wielded appropriately, Content Analysis can illuminate the density and frequency of certain themes within a dataset, provide insights into how specific terms or concepts are applied contextually, and offer inferences about the meanings of their content and use (Duriau, Reger, & Pfarrer, 2007).

Example of Content Analysis

Title: Framing European politics: A content analysis of press and television news .

Citation: Semetko, H. A., & Valkenburg, P. M. (2000). Framing European politics: A content analysis of press and television news. Journal of Communication, 50 (2), 93-109.

Overview: This study analyzed press and television news articles about European politics using a method called content analysis. The researchers examined the prevalence of different “frames” in the news, which are ways of presenting information to shape audience perceptions. They found that the most common frames were attribution of responsibility, conflict, economic consequences, human interest, and morality.

Read my Full Guide on Content Analysis Here

12. Discourse Analysis

Definition: Discourse Analysis, a qualitative research method, interprets the meanings, functions, and coherence of certain languages in context.

Discourse analysis is typically understood through social constructionism, critical theory , and poststructuralism and used for understanding how language constructs social concepts (Cheek, 2004).

Discourse Analysis offers great breadth, providing tools to examine spoken or written language, often beyond the level of the sentence. It enables researchers to scrutinize how text and talk articulate social and political interactions and hierarchies.

Insight can be garnered from different conversations, institutional text, and media coverage to understand how topics are addressed or framed within a specific social context (Jorgensen & Phillips, 2002).

Example of Discourse Analysis

Title: The construction of teacher identities in educational policy documents: A critical discourse analysis

Citation: Thomas, S. (2005). The construction of teacher identities in educational policy documents: A critical discourse analysis. Critical Studies in Education, 46 (2), 25-44.

Overview: The author examines how an education policy in one state of Australia positions teacher professionalism and teacher identities. While there are competing discourses about professional identity, the policy framework privileges a  narrative that frames the ‘good’ teacher as one that accepts ever-tightening control and regulation over their professional practice.

Read my Full Guide on Discourse Analysis Here

13. Action Research

Definition: Action Research is a qualitative research technique that is employed to bring about change while simultaneously studying the process and results of that change.

This method involves a cyclical process of fact-finding, action, evaluation, and reflection (Greenwood & Levin, 2016).

Typically, Action Research is used in the fields of education, social sciences , and community development. The process isn’t just about resolving an issue but also developing knowledge that can be used in the future to address similar or related problems.

The researcher plays an active role in the research process, which is normally broken down into four steps: 

• developing a plan to improve what is currently being done
• implementing the plan
• observing the effects of the plan, and
• reflecting upon these effects (Smith, 2010).

Example of Action Research

Title: Using Digital Sandbox Gaming to Improve Creativity Within Boys’ Writing

Citation: Ellison, M., & Drew, C. (2020). Using digital sandbox gaming to improve creativity within boys’ writing. Journal of Research in Childhood Education , 34 (2), 277-287.

Overview: This was a research study one of my research students completed in his own classroom under my supervision. He implemented a digital game-based approach to literacy teaching with boys and interviewed his students to see if the use of games as stimuli for storytelling helped draw them into the learning experience.

Read my Full Guide on Action Research Here

14. Semiotic Analysis

Definition: Semiotic Analysis is a qualitative method of research that interprets signs and symbols in communication to understand sociocultural phenomena. It stems from semiotics, the study of signs and symbols and their use or interpretation (Chandler, 2017).

In a Semiotic Analysis, signs (anything that represents something else) are interpreted based on their significance and the role they play in representing ideas.

This type of research often involves the examination of images, sounds, and word choice to uncover the embedded sociocultural meanings. For example, an advertisement for a car might be studied to learn more about societal views on masculinity or success (Berger, 2010).

Example of Semiotic Research

Title: Shielding the learned body: a semiotic analysis of school badges in New South Wales, Australia

Citation: Symes, C. (2023). Shielding the learned body: a semiotic analysis of school badges in New South Wales, Australia. Semiotica , 2023 (250), 167-190.

Overview: This study examines school badges in New South Wales, Australia, and explores their significance through a semiotic analysis. The badges, which are part of the school’s visual identity, are seen as symbolic representations that convey meanings. The analysis reveals that these badges often draw on heraldic models, incorporating elements like colors, names, motifs, and mottoes that reflect local culture and history, thus connecting students to their national identity. Additionally, the study highlights how some schools have shifted from traditional badges to modern logos and slogans, reflecting a more business-oriented approach.

15. Qualitative Longitudinal Studies

Definition: Qualitative Longitudinal Studies are a research method that involves repeated observation of the same items over an extended period of time.

Unlike a snapshot perspective, this method aims to piece together individual histories and examine the influences and impacts of change (Neale, 2019).

Qualitative Longitudinal Studies provide an in-depth understanding of change as it happens, including changes in people’s lives, their perceptions, and their behaviors.

For instance, this method could be used to follow a group of students through their schooling years to understand the evolution of their learning behaviors and attitudes towards education (Saldaña, 2003).

Example of Qualitative Longitudinal Research

Title: Patient and caregiver perspectives on managing pain in advanced cancer: a qualitative longitudinal study

Citation: Hackett, J., Godfrey, M., & Bennett, M. I. (2016). Patient and caregiver perspectives on managing pain in advanced cancer: a qualitative longitudinal study.  Palliative medicine ,  30 (8), 711-719.

Overview: This article examines how patients and their caregivers manage pain in advanced cancer through a qualitative longitudinal study. The researchers interviewed patients and caregivers at two different time points and collected audio diaries to gain insights into their experiences, making this study longitudinal.

Read my Full Guide on Longitudinal Research Here

16. Open-Ended Surveys

Definition: Open-Ended Surveys are a type of qualitative research method where respondents provide answers in their own words. Unlike closed-ended surveys, which limit responses to predefined options, open-ended surveys allow for expansive and unsolicited explanations (Fink, 2013).

Open-ended surveys are commonly used in a range of fields, from market research to social studies. As they don’t force respondents into predefined response categories, these surveys help to draw out rich, detailed data that might uncover new variables or ideas.

For example, an open-ended survey might be used to understand customer opinions about a new product or service (Lavrakas, 2008).

Contrast this to a quantitative closed-ended survey, like a Likert scale, which could theoretically help us to come up with generalizable data but is restricted by the questions on the questionnaire, meaning new and surprising data and insights can’t emerge from the survey results in the same way.

Example of Open-Ended Survey Research

Title: Advantages and disadvantages of technology in relationships: Findings from an open-ended survey

Citation: Hertlein, K. M., & Ancheta, K. (2014). Advantages and disadvantages of technology in relationships: Findings from an open-ended survey.  The Qualitative Report ,  19 (11), 1-11.

Overview: This article examines the advantages and disadvantages of technology in couple relationships through an open-ended survey method. Researchers analyzed responses from 410 undergraduate students to understand how technology affects relationships. They found that technology can contribute to relationship development, management, and enhancement, but it can also create challenges such as distancing, lack of clarity, and impaired trust.

17. Naturalistic Observation

Definition: Naturalistic Observation is a type of qualitative research method that involves observing individuals in their natural environments without interference or manipulation by the researcher.

Naturalistic observation is often used when conducting research on behaviors that cannot be controlled or manipulated in a laboratory setting (Kawulich, 2005).

It is frequently used in the fields of psychology, sociology, and anthropology. For instance, to understand the social dynamics in a schoolyard, a researcher could spend time observing the children interact during their recess, noting their behaviors, interactions, and conflicts without imposing their presence on the children’s activities (Forsyth, 2010).

Example of Naturalistic Observation Research

Title: Dispositional mindfulness in daily life: A naturalistic observation study

Citation: Kaplan, D. M., Raison, C. L., Milek, A., Tackman, A. M., Pace, T. W., & Mehl, M. R. (2018). Dispositional mindfulness in daily life: A naturalistic observation study. PloS one , 13 (11), e0206029.

Overview: In this study, researchers conducted two studies: one exploring assumptions about mindfulness and behavior, and the other using naturalistic observation to examine actual behavioral manifestations of mindfulness. They found that trait mindfulness is associated with a heightened perceptual focus in conversations, suggesting that being mindful is expressed primarily through sharpened attention rather than observable behavioral or social differences.

Read my Full Guide on Naturalistic Observation Here

18. Photo-Elicitation

Definition: Photo-elicitation utilizes photographs as a means to trigger discussions and evoke responses during interviews. This strategy aids in bringing out topics of discussion that may not emerge through verbal prompting alone (Harper, 2002).

Traditionally, Photo-Elicitation has been useful in various fields such as education, psychology, and sociology. The method involves the researcher or participants taking photographs, which are then used as prompts for discussion.

For instance, a researcher studying urban environmental issues might invite participants to photograph areas in their neighborhood that they perceive as environmentally detrimental, and then discuss each photo in depth (Clark-Ibáñez, 2004).

Example of Photo-Elicitation Research

Title: Early adolescent food routines: A photo-elicitation study

Citation: Green, E. M., Spivak, C., & Dollahite, J. S. (2021). Early adolescent food routines: A photo-elicitation study. Appetite, 158 .

Overview: This study focused on early adolescents (ages 10-14) and their food routines. Researchers conducted in-depth interviews using a photo-elicitation approach, where participants took photos related to their food choices and experiences. Through analysis, the study identified various routines and three main themes: family, settings, and meals/foods consumed, revealing how early adolescents view and are influenced by their eating routines.

Features of Qualitative Research

Qualitative research is a research method focused on understanding the meaning individuals or groups attribute to a social or human problem (Creswell, 2013).

Some key features of this method include:

• Naturalistic Inquiry: Qualitative research happens in the natural setting of the phenomena, aiming to understand “real world” situations (Patton, 2015). This immersion in the field or subject allows the researcher to gather a deep understanding of the subject matter.
• Emphasis on Process: It aims to understand how events unfold over time rather than focusing solely on outcomes (Merriam & Tisdell, 2015). The process-oriented nature of qualitative research allows researchers to investigate sequences, timing, and changes.
• Interpretive: It involves interpreting and making sense of phenomena in terms of the meanings people assign to them (Denzin & Lincoln, 2011). This interpretive element allows for rich, nuanced insights into human behavior and experiences.
• Holistic Perspective: Qualitative research seeks to understand the whole phenomenon rather than focusing on individual components (Creswell, 2013). It emphasizes the complex interplay of factors, providing a richer, more nuanced view of the research subject.
• Prioritizes Depth over Breadth: Qualitative research favors depth of understanding over breadth, typically involving a smaller but more focused sample size (Hennink, Hutter, & Bailey, 2020). This enables detailed exploration of the phenomena of interest, often leading to rich and complex data.

Qualitative vs Quantitative Research

Qualitative research centers on exploring and understanding the meaning individuals or groups attribute to a social or human problem (Creswell, 2013).

It involves an in-depth approach to the subject matter, aiming to capture the richness and complexity of human experience.

Examples include conducting interviews, observing behaviors, or analyzing text and images.

There are strengths inherent in this approach. In its focus on understanding subjective experiences and interpretations, qualitative research can yield rich and detailed data that quantitative research may overlook (Denzin & Lincoln, 2011).

Additionally, qualitative research is adaptive, allowing the researcher to respond to new directions and insights as they emerge during the research process.

However, there are also limitations. Because of the interpretive nature of this research, findings may not be generalizable to a broader population (Marshall & Rossman, 2014). Well-designed quantitative research, on the other hand, can be generalizable.

Moreover, the reliability and validity of qualitative data can be challenging to establish due to its subjective nature, unlike quantitative research, which is ideally more objective.

Compare Qualitative and Quantitative Research Methodologies in This Guide Here

In conclusion, qualitative research methods provide distinctive ways to explore social phenomena and understand nuances that quantitative approaches might overlook. Each method, from Ethnography to Photo-Elicitation, presents its strengths and weaknesses but they all offer valuable means of investigating complex, real-world situations. The goal for the researcher is not to find a definitive tool, but to employ the method best suited for their research questions and the context at hand (Almalki, 2016). Above all, these methods underscore the richness of human experience and deepen our understanding of the world around us.

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• Open access
• Published: 17 April 2024

Breaking down barriers to mental healthcare access in prison: a qualitative interview study with incarcerated males in Norway

• Line Elisabeth Solbakken 1 , 2 ,
• Svein Bergvik 3 &
• Rolf Wynn 1 , 4  

BMC Psychiatry volume  24 , Article number:  292 ( 2024 ) Cite this article

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Metrics details

Mental health problems are highly prevalent in prison populations. Incarcerated persons generally come from disadvantaged backgrounds and are living under extraordinary conditions while in prison. Their healthcare needs are complex compared to the general population. Studies have found that incarcerated individuals are reluctant to seek help and that they experience challenges in accessing mental healthcare services. To some extent, seeking treatment depends on the degree of fit between potential users and health services, and actual use might be a better indication of accessibility than the fact that services are available. This study aimed to explore individual and systemic facilitators and barriers to accessing mental healthcare in a prison context.

An analytical approach drawing on elements of constructivist Grounded theory was the methodological basis of this study. Fifteen male participants were recruited from three prisons in Northern Norway. Data was collected through in-depth interviews on topics such as help-seeking experiences, perceived access to services and availability of health information.

We found that distrust in the system, challenges with the referral routines, worries about negative consequences, and perceived limited access to mental healthcare were barriers to help-seeking among incarcerated individuals. How prison officers, and healthcare personnel respond to incarcerated persons reporting mental distress could also be critical for their future willingness to seek help. Providing information about mental health and available services, initiating outreaching mental health services, and integrating mental health interventions into treatment programs are examples of efforts that might reduce barriers to accessing services.

Conclusions

Facilitating access to mental health services is crucial to accommodate the mental health needs of those incarcerated. This study provides insights into the complex interplay of individual, social and systemic factors that may contribute to the utilization of mental health care among incarcerated persons. We suggest that correctional and healthcare systems review their practices to facilitate access to healthcare for people in prison.

Peer Review reports

Mental health of people in prison

The rates of mental disorders are considerably higher among incarcerated individuals than in the general population [ 1 , 2 , 3 , 4 ]. Co-morbidities are common, and around 20% of incarcerated individuals have concurrent mental and substance use disorders [ 5 ]. They are at increased risk for all-cause mortality, self-harm, violence, and victimization, and suicide rates are about 3–6 times higher among incarcerated males relative to males in the broader population [ 6 ]. Adverse life experiences and disadvantaged living conditions from an early age may explain the observed accumulation of mental health problems in prison populations worldwide [ 7 , 8 ]. Genetic predispositions combined with environmental stressors are implicated in the development of mental disorders [ 9 , 10 ]. People in prison generally experience low educational achievements, low income, and unstable housing. Thus, the poor mental health of prison populations is caused by a complex interplay of social, environmental, and genetic factors [ 7 , 11 ]. In addition to the pre-existing burdens, incarcerated individuals are facing prison–specific challenges such as loss of autonomy, social isolation, bullying and violence that may exacerbate mental health issues [ 12 , 13 , 14 , 15 ]. Considering the elevated rates of mental health problems in prison, facilitating access to mental health services is crucial to accommodate the needs of those incarcerated.

Access to mental health services

The treatment gap refers to the proportion of individuals with mental health problems within a specific community that require treatment without receiving it [ 16 ]. Variable access to mental healthcare and high levels of unmet mental health needs are universal challenges in communities across the world [ 17 , 18 ]. Even when health services are available, individual and systemic barriers may hinder their use. In a narrow sense, access to healthcare may be considered equivalent to available services. However, some argue that a more meaningful way to define access is the “degree of fit” between the potential users and health services [ 19 ]. For instance, if services are accessible in terms of transportation and treatment costs and whether they are compatible with potential users’ personal attitudes, beliefs and preferences. “Having access” can be understood as the potential for using available mental health services. “Gaining access”, is the individual process of choosing to use those services [ 20 ]. Within this frame of reference, access to services is more precisely defined by the actual use of services.

Mental health help-seeking

Across settings and populations, the majority of those suffering from mental health problems do not seek treatment [ 21 , 22 , 23 ]. The literature on help-seeking gives insight into the intrapersonal factors involved in accessing mental health care. Within this context, help-seeking has been defined as: " an adaptive coping process that is the attempt to obtain external assistance to deal with a mental health concern” [ 24 ]. The process of seeking help involves becoming aware of a mental health problem that may require intervention; articulating the psychological challenges in a way that can be understood by others; awareness of help sources that are available and accessible; and a willingness to talk about the mental health problem to available help sources [ 25 ]. Throughout the help-seeking process, personal thoughts and feelings become increasingly interpersonal as an individual confides in and seeks support from others. It is not uncommon to share mental health concerns with informal sources of support such as friends and family prior to, or even instead of, seeking professional help [ 26 ]. Moreover, informal networks are found to facilitate but may also discourage professional formal help-seeking for mental health problems [ 27 , 28 ].

The theory of planned behavior (TPB), a well-known model within behavior change research, may also provide a framework for understanding how personal attitudes and social influences are implicated in accessing healthcare. Subjective norms, attitudes, and perceived behavioral control are elements of TPB that are particularly important for understanding the help-seeking process [ 29 ]. In this context, subjective norms refer to a person’s beliefs about other peoples’ practice or approval of help-seeking and are related to expectations of social support in pursuing professional help. Attitudes refer to appraisals of seeking professional mental help as beneficial or harmful and a judgement of whether help-seeking would be constructive compared to alternative behaviors. Perceived behavioral control can be divided into self-efficacy (the confidence that one can seek help), and controllability (the extent of personal control in the help-seeking process). A recent review found that attitudes and perceived behavioral control predict help-seeking intentions across different population groups and cultures [ 30 ].

Access to mental health services in prison

Equity is essential in healthcare to ensure that the health system meets the needs of different groups of people and individuals [ 20 ]. “The principle of equivalence” is a widely endorsed standard for healthcare in correctional settings [ 31 ]. This principle is laid down in the United Nations´ Nelson Mandela Rules. Rule number 24 states that: “Prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary health-care services free of charge without discrimination on the grounds of their legal status” [ 32 ] (p.8) However, some argue that equal standards are not sufficient to meet the complex needs of incarcerated individuals and that mental healthcare in prison must be more intensive and integrative than services provided in the community [ 33 , 34 , 35 ]. In reality there are several reports of shortcomings in the delivery of mental healthcare in prison in many countries across the world, as mental disorders in incarcerated persons are underdiagnosed and undertreated [ 6 , 34 ]. Studies from Canada, the US, and the UK indicate that a significant proportion of incarcerated people with mental health problems have not received adequate treatment [ 36 , 37 , 38 , 39 ]. Suggested explanations for unmet needs are underfunding, failure in screening procedures and quality at reception, demand for more mental health knowledge among prison staff, and possible underrating of the severity of mental health problems by the prison administrations to reduce treatment costs [ 36 , 37 , 38 , 39 , 40 ]. Taken together these reports suggest that mental health services do not fit the complex needs of incarcerated persons in high-income countries. There is less knowledge about the situation in low- and middle-income countries. However, the elevated rates of mental disorders in these countries suggest that unmet needs among incarcerated persons are a widespread challenge [ 1 ].

Mental health help-seeking in prison

Evidence suggests that the immense burden of mental disorders among people in prison is not matched by a proportional use of mental healthcare [ 41 ]. Several reports from various correctional settings have documented that incarcerated persons are reluctant to seek help for mental health problems [ 41 ]. Among the reported barriers to help-seeking in prison are confidentiality concerns [ 42 ], fear of stigma associated with a diagnosis [ 43 ], a preference for self-management or informal support [ 44 ], lack of knowledge of psychological services [ 42 , 44 ] and distrust in the system [ 45 ]. In addition, systemic factors may influence access to healthcare in prison. The culture in all-male prisons typically demands that those imprisoned mask their vulnerabilities by adopting a tough and dominant demeanor [ 46 ]. Experiencing mental illness and receiving professional mental health treatment is also associated with an increased risk of victimization in incarcerated individuals [ 47 ].

Mental health literacy (MHL) is a concept that includes the knowledge and attitudes that influence how people manage their mental health needs [ 48 ]. Having sufficient knowledge and access to information about mental health and mental health services can be a prerequisite for seeking professional help [ 49 ]. For people living in the community, seeking online information and advice is an important strategy for gaining knowledge about how to cope with mental health challenges [ 50 , 51 , 52 ]. For security reasons, access to the Internet is typically severely limited for those imprisoned [ 53 , 54 ]. Hence, this essential mental health information source is largely unavailable to them. Accordingly, incarcerated individuals are reliant on finding mental health information through information pamphlets, books, TV programs, newspapers or consulting healthcare professionals [ 55 ]. Some argue that limited access to online information and digital health services may have consequences for the well-being and successful rehabilitation of those incarcerated [ 53 , 56 , 57 ]. Thus, there are reasons to believe that restricted access to mental health information may also affect help-seeking and access to healthcare for incarcerated individuals.

The rationale for the current study

Fostering health-promoting environments and adequate access to mental healthcare within prisons is a public health imperative increasingly acknowledged in the literature [ 33 ]. Moreover, the mental health of incarcerated persons is a matter of public safety since untreated severe mental disorders are associated with a higher risk of recidivism [ 58 , 59 ]. People in prison retain their right to health services, and in principle, incarcerated persons have access to mental health services. A vital question, however, is how incarcerated persons experience gaining access and how this affects their actual use of services. Existing research on the provision of mental healthcare in prisons, particularly within a Scandinavian context, is sparse, leaving significant knowledge gaps. The question of access to health information for incarcerated persons is similarly understudied. This study aimed to investigate how incarcerated persons experience individual and systemic factors that facilitate or impede access to mental healthcare in prison.

The Helsinki Declaration of Medical Research involving human subjects and services laid the basis of the ethical considerations of this study [ 60 ]. The study was approved by the Data Protection Officer of the University Hospital of North Norway (No. 02415). The Norwegian Correctional system, which is responsible for the welfare of incarcerated individuals, approved of the study (Ref. 200900463-347). The Regional Health Research Ethics Committee concluded that the project was outside their mandate (Ref. 40,701).

The principles of voluntariness and informed consent are central to human subject research. Individuals in prison are considered vulnerable due to their restricted freedom and autonomy, poor health status, higher incidence of learning disabilities, and lower literacy levels. Consequently, additional precautions are required to ensure that research with incarcerated participants is conducted ethically [ 61 ]. User participation in designing research that includes vulnerable groups is crucial to achieving this objective [ 61 , 62 ]. Measures in accordance with recommendations were taken to ensure consent information that is complete, relevant, and understandable [ 63 ]. A user representative from Way-Back, an organization that supports incarcerated persons with reentry to their communities, contributed to the project’s planning. The user representative provided input on information about the study, research questions, the interview guide and how to conduct the interviews. The input was used to tailor information and for conducting the interviews in accordance with the constraints of the prison contexts and the needs of the incarcerated individuals. The choice of whether to reimburse participants in prison studies is debated. Because of the relative deprivation of prison life, some argue that even small incentives could potentially result in undue influence for participation in research [ 64 ]. For this reason, we chose to abstain from offering reimbursement for the participants in this study.

Study context

At any given time, about 3000 persons are serving a sentence in Norway, of which 5.6% are women and 26.2% are non-Norwegian citizens [ 65 ]. A recent study found that almost 60% of incarcerated persons in Norway had a diagnosed mental disorder, together with a 33% rise in the one-year prevalence of mental disorders between the years 2010–2019 [ 66 ]. Thus, the proportion of people with mental disorders entering prison has been increasing. In Norway, access to necessary healthcare is considered a basic human right and is legislated in the Patient’s Rights Act section 2 [ 67 ]. Healthcare is primarily tax-funded, with a nominal service fee and a relatively low cap on yearly individual costs [ 68 ]. Norway has committed to “the principle of equivalence” meaning that those imprisoned retain their right to healthcare equal to that of the general population [ 31 ]. Prison health services serve incarcerated persons with milder mental health problems and are accessible by self-referral through a paper-based request system. The prison health services can refer those who experience moderate to severe mental disorders to specialist mental health services, and treatment is often provided in prison by mental health professionals from local hospitals For people imprisoned in Norway, healthcare and medications are free of charge [ 69 ], eliminating one significant barrier to mental healthcare access [ 70 ]. Furthermore, as the municipalities and local hospitals provide health services - the importation of services promotes equity and that services are independent of the correctional system, thereby strengthening the rights of people in prison [ 71 ].

A study found that incarcerated persons in Norway were reluctant to seek help for mental health problems from prison health services unless they had concurrent sleep or substance use problems [ 72 ]. A survey by Bjørngaard et al. [ 73 ] found lower patient satisfaction with prison health services compared to people using community health services and that those with mental health problems were less satisfied compared to incarcerated patients with other health challenges. A survey representative of the Norwegian prison population found that 20% of incarcerated males sample reported that they had received mental health services, while 25% reported that they had been in need of mental health services in prison but had not received any [ 11 ]. More recent reports suggest that mental health services are insufficient to meet the needs of those imprisoned in Norway and that incarcerated individuals referred due to their severe mental illness may not be admitted to specialist services for in-patient assessment and treatment [ 74 , 75 ]. These reports indicate that mental health services do not fit the complex needs of incarcerated persons in Norway and that there are potential obstacles in their access to mental healthcare.

Study design

This study was underpinned by relativist epistemology which is based on the assumption of multiple individual realities that allow for different understandings of the same phenomenon [ 76 ]. The study design was suitable for exploring and explaining commonly experienced individual, social, cultural and structural factors that influence help-seeking and access to mental healthcare for incarcerated individuals. The study incorporates vital Grounded Theory (GT) components, including initial coding, categorizing data, constant comparative methods involving inductive and abductive reasoning, and memoing [ 77 ]. The use of theoretical sampling, which is rare in prison research due to ethical and practical constraints [ 78 ], was not employed in this study. Data collection concluded once additional data no longer contributed new insights or further elaborated the developed categories.

Preconceptions

The first author, a clinical community psychologist and a PhD student, worked part-time as a prison officer for two years during her psychology education. This experience gave her an insider’s view of the correctional system, inevitably influencing her initial perceptions. Before conducting the interviews, she held a somewhat optimistic view of the correctional system’s capacity to support and enhance the mental health of those incarcerated. However, this perspective was challenged through the narratives of the study participants, who conveyed powerful personal accounts that highlighted substantial barriers to obtaining mental health services within the prison environment. The other two authors, serving as supervisors, are also researchers and mental health professionals with considerable clinical experience. Their diverse backgrounds contributed to a supervisory dynamic that adresssed the research topic’s complexities. Throughout the study, the authors engaged in a process of collaborative reflection, concerned with maintaining a balance between engaging with participant stories and sustaining a critical stance towards the data. These discussions were essential in helping the first author navigate an empathetic understanding of the participant’s experiences with the necessary analytical objectivity required for rigorous qualitative research.

Participants and study settings

Fifteen males serving a prison sentence were recruited from three prisons in Northern Norway. Thirteen of the participants served a sentence at a high security level, while two served at lower security. The participants’ age ranged from the early twenties to the late sixties (M: 43.6 years). Two participants had other nationalities, while the rest were Norwegian citizens. Further details about the participants must be withheld to preserve their privacy. When citing individual participants, they are anonymized by using pseudonyms.

Recruitment

Participants were recruited through posters in the prison ward that conveyed basic information, including the fact that the interviews were confidential and would be recorded. The posters encouraged those interested in participating to approach a contact person for more information. A prison officer, a social worker or a reintegration coordinator were assigned the role as contact persons in the selected prisons. Those who actively approached the contact person were given more comprehensive written information about the study. Requiring an active choice by incarcerated individuals was done to enhance their experience of self-determination and autonomy in their decision to participate. The contact person scheduled appointments with the participants, and the interviewer had no prior knowledge of the participants other than what they presented in the interviews. One potential participant cancelled the interview appointment due to health issues on the interview day and withdrew from the study.

The first author conducted face-to-face, in-depth interviews. The interviews took place in prison visitation rooms or in an office in the health wards. Before the interview, the participants were given information about the study and their rights as research participants and signed a written consent form. The interviewer was alone with the participants during the interview and had a personal alarm as a safety precaution. The interview guide covered topics on knowledge of mental health and available services, help-seeking experiences, and access to mental health information (sample questions provided in Table  1 ). The participants were asked open-ended questions and were invited to speak freely on these topics. Thus, the order and framing of questions varied depending on where they fit into the participants’ narratives. This allowed for following up on the participants’ experiences and may have given the participants an increased sense of control in the interview. The first author who conducted the interviews was attentive to signs of emotional discomfort in participants and avoided pressure on sensitive topics. After the interviews, the participants were encouraged to ask questions and comment on their experience and reminded of their right to withdraw from the study. Nearly all the participants expressed that the experience of participating in the study was positive and that they appreciated the chance to contribute to the research project.

The first author transcribed the audio-recorded interviews in Norwegian, ensuring a verbatim account of the participants’ narratives. The initial eight interviews were transcribed before initiating data analysis. This early examination of the data facilitated a refinement of the interview guide, which was then applied to the subsequent seven interviews to deepen the inquiry. Data collection and analysis were concurrent as the study progressed from the ninth interview, which allowed for immediate integration of new data into the evolving analytical framework. The data was examined using the NVivo 12 software, which supported the systematic organization and analysis of the data. The data was analyzed line-by-line, searching for incidents in the form of recurring beliefs, actions, experiences, and explanations [ 79 ]. The constant comparison method was applied throughout the analysis. In the initial coding phase, incidents were compared to incidents, and through this process underlying recurring concepts and similarities were identified and assigned codes. Subsequently, codes were then compared to codes, and related codes were organized into conceptual categories, reflecting both common features and divergent viewpoints [ 77 ]. In the intermediate coding phase, the data was abstracted into categories which were compared to each other, and relationships between categories were developed and refined. The authors engaged in a collaborative and reflective dialogue throughout this process, meeting regularly to deliberate on preconceptions, the emerging categories and their interpretations. This dynamic exchange was informed by memos that captured analytical decisions, insights, and evolving interpretations, thus guiding the reflective process. In the last stage, advanced coding, a core category which binds the other categories and sub-categories together was developed. Through a collaborative process the categories were substantiated with representative quotes, which, upon completion of the analysis, were translated from Norwegian to English for inclusion in the report. This resulted in a nuanced understanding grounded in the participants’ experiences and the researchers’ interpretative lens.

The data analysis yielded four main categories illustrating the participants’ active engagement in identifying challenges and facilitators for mental healthcare access within the prison environment. The first category, “Mental health awareness,” captures how beliefs and knowledge concerning mental health were influenced by the experiences and constraints inherent to prison life, potentially affecting the pursuit of help and access to healthcare services. The second main category reveals how systemic sub-cultural values can obstruct healthcare access, whereas, on a personal level, fellow inmates served as vital support for obtaining mental health services. The third main category, “Access to mental health care,” examines how organizational and systemic barriers impede access to mental healthcare. The final main category, “Enhancing access to services,” delineates factors that lowered the bar for mental healthcare access. The core category, “Breaking down barriers,” encapsulates the dynamic interplay between incarcerated individuals and the contextual factors that influenced their ability and willingness to access mental healthcare in prison. This central theme also recognizes the collaborative effort between participants and researchers in identifying problem areas and solutions to mental healthcare access, thereby “breaking down barriers”. An outline of these categories is presented in Table  2 .

Mental health awareness

An information void.

Seeking information can be an essential first step for recognizing symptoms of mental illness that may require intervention. Prior to imprisonment, visiting their general practitioner or using online search engines were the preferred methods for finding health information for the participants in this study. In prison, however, access to the Internet is severely limited:

Where can we get information? We do not have access to computers or anything. So, I would have to call someone on the outside to get them to print articles and send them to me by post. So, no. We don’t know our rights, we don’t know about the services available to us, as a matter of fact we know very little. There’s an information void. Stuart

A few of the participants referred to the prison library as a source of information. Some also said that they could talk to health care professionals, correctional officers, or other staff members like the priest, to get mental health information. Fellow incarcerated individuals who had experienced mental health problems and received health services were also mentioned by some participants. The common thread in all suggestions was a dependency on others to access information about mental health. Only a couple of participants had tried to find mental health information during their time in prison. However, they found it difficult to obtain:

The only choice I have is to ask the prison officers to print it [mental health information], but sometimes they don’t want to do it because they think it’s bad. And I have tried to search for psychosis and such in school [in prison], but then the teachers ask why I would seek out such a gloomy subject. It feels a bit complicated to obtain information. Larry

Participants from all three prisons also pointed out the need for more information about mental healthcare in prison:

We have a notice board on the ward (…). The information should be hung there for people to see, that there is a psychologist here, and that you can talk to her. ‘cause I’ve seen little of that sort in here. Liam

One participant underscored that information about available mental health services is particularly important for those with no experience from such services prior to imprisonment:

It [information] must tell you about your opportunities. To normalize it [seeking help] in a way. And the threshold must be low. I think many experience that it is too high. If I hadn’t been in contact with mental health services before I came here, the threshold for seeking help would have been sky high for me as well. Neil

Awareness of mental health issues

Factors in the prison context were fundamental to the participants’ explanations of mental health problems. Many participants attributed the onset or worsening of mental health problems to the shock of imprisonment and to the continuous hardships of prison life. Understanding symptoms as primarily caused by external stressors such as prison hardship may have influenced their appraisals about the need to seek help. As Frank stated:

I’ve always had good mental health. Until I came here, inside these walls. Frank

Frank reported considerable symptoms of post-traumatic stress. Understanding his symptoms as something triggered by the prison living conditions, he did not see how seeking professional help could benefit him. Like many other participants, he insisted that the correctional system needed to change and had lost hope that he could improve his own situation.

In contrast, other participants who attributed their mental health problems to external stressors concluded that they indeed needed help to cope. The suffering they experienced during their first weeks in prison motivated them to seek formal help:

I asked to talk to a psychologist in here. ‘Cause, I felt that I needed to. ‘Cause in the beginning when I came here, it all seemed dark. No matter how hard I tried to do the right thing, there was some sort of dark force that was just pushing on, and the obstacles were piling up. Travis

For some, their main motivation for seeking help was to receive professional validation from healthcare personnel regarding the negative health consequences of their prison experiences. Some also hoped that healthcare professionals could advocate for better living conditions:

And it is good that others [psychologists] can take part in these things. So that it is manifested what prisons actually do to people. Jack

Social influences on help-seeking

Prison culture and mental health stigma.

The participants described how the culture within prison influenced their willingness to talk about mental health issues. The importance of appearing strong and dominant within the prison setting was emphasized by many. According to several participants, the talk at the wards was characterized by attempts to one-up the others’ stories about criminal activities to appear tough. Many also explained that hiding vulnerabilities was critical in the prison community, and some also underlined the potential for victimization for those who were not able to conform to the prison norms:

You are wearing a prison mask. You cannot show weakness. ‘Cause then you’ll soon be a victim, a sitting duck. I have experienced inmates that have, eh mostly stayed in their cells. They have been harassed so badly that they are sitting there crying. The prison milieu can be tough. Neil

Choosing to confide in and seek advice from peers can also have negative consequences. Several of the participants said that it was wise to be careful with who you chose to share mental health related issues with:

Let’s say you talk about your personal feelings, and about your sentence and stuff, right. They can be very nice to you there and then, before they stab you in the back later on, spreading everything you’ve said to destroy you. It is a cynical game. Bobby

Bobby went on to explain that a fellow incarcerated individual could use personal information for harassing, blackmailing and threatening the family of someone who has confided in them, if a conflict should arise. Some of the participants also addressed directly how the prison climate may influence willingness to seek mental health treatment:

They do not want to go to a psychologist and talk. Because then they are seen as weak and not able to cope. Because in prison everyone should be tough. Drug lords and such. But, on the inside they are not like that. Nicky

The role of peers in accessing mental health services

Despite the clear barriers, fellow incarcerated appeared to be an important informal help source for mental health problems. Many of the participants had observed signs of emotional distress among their incarcerated peers and described how they had given them advice and encouragement. According to several participants, those imprisoned also had an essential role in recognizing mental health problems in their peers:

There is no-one who talks to us regularly to check on how we are doing. That’s not a priority here. So, unless some of the inmates take on the role of an officer or a psychologist, then there’s no-one who reports concern (…) There are many inmates who are taking on a role as a social worker, but it’s kinda wrong. They are neither paid for it, nor qualified. They do it because no-one else does. Stuart

Although none of the participants said that they themselves had been prompted to seek help by peers, they told stories of how they had pushed their peers to seek formal help:

A fellow inmate. I could tell he was struggling because he talked to me as the only person. In a way, I was his psychologist. The days when he was down in the dumps, I tried to talk to him (…) And I said, listen up. It’s for your own good. I will write a request form, and we will arrange contact with a psychologist (…) and it will help. Nicky

Experiencing fellow incarcerated people in distress appeared to be common, and participants also explained how they reported to prison officers their concerns about peers with self-harm and suicide plans:

There was a fella’ who told me that he knew exactly how to take his own life (…). “I’ll just do it like this and this and this”. And, uhm. Then he said he was going to do it. And I thought that I would have to report it, and I did. Roy

Roy went on to describe in detail how his reported concern led to a prison officer interrupting the suicide attempt by the fellow incarcerated, thereby saving his life. Several other participants shared similar stories, indicating that peers played a significant role in recognizing and getting help for mental health related problems in prison.

Access to mental healthcare

Self-referral and disempowerment.

In order to access prison healthcare, those imprisoned must write and deliver a paper-based request form. All the participants in this study were aware that this is the way to contact prison healthcare, and most of them knew that the general practitioner working at the prison could refer them to a psychologist or to a psychiatric hospital. Unfortunately, the request form system seemed to amplify the participants’ perceptions of disempowerment. Rather than seeing themselves as agents taking charge of their own situation and health, they were left passively waiting to be contacted after filling out the forms:

You are pacified when you must write a request form to talk to someone. Then you don’t know when they are coming to talk to you. And then it’s like, the problem may be swept under the rug when they finally get to you. Tommy

According to the participants, many of these request forms seemed to disappear, and it could take an exceedingly long time before they got any response to their request:

Many times, when you write a request form it disappears. Nothing happens. Those request forms are worthless most of the time. Keith

There were also several participants who voiced concern over the confidentiality of the request forms even when the forms were delivered in closed envelopes:

We can see for ourselves that they [prison officers] open and read, uhm, confidential information, [lowers his voice] and to put it mildly, uhm, breaches in confidentiality are all too common. It is alarming! Neil

One of the informants also explained that incarcerated persons who had mother tongues other than Norwegian could have problems with understanding and filling out request forms to health, and that forms that were not filled out correctly were of no value. According to Roy and other participants, the correctional system did not give sufficient information and guidance about the request forms:

They might not know how to write, or understand what it [the form] says, you know? Potentially it is severe for that guy, right. It’s garbage! Garbage, that request form. They haven’t received any request from him. Roy

The perceived availability of mental healthcare

The perceptions of accessibility of mental health care varied between the participants. A few of the participants were in active treatment with a psychologist at the time of the interviews, and they had experienced the access as unproblematic. Common for some of these participants was that they had been in treatment before they entered prison:

From sending my request and to receiving an acceptance letter it took one and a half weeks. Less than three weeks later I was in treatment. It was efficient. Much quicker than I’ve ever experienced before. Neil

However, many participants said that they could not access secondary mental health services. There were two notable sub-groups among the participants who perceived that access to specialized psychological treatment was limited. The first group shared stories about living unstructured lives at the edge of society. They seemed to have little confidence in health care and correctional services, and were less hopeful of their own potential of being rehabilitated:

I have tried for several years now, but I didn’t get help. They can say whatever they want about how easy it is to access a psychologist and prison healthcare and everything, but it is not true. Ronny

Two of the participants explained how they would have to take drastic measures such as performing violent acts or acting weird to get help for their mental health problems When Marlon was asked how he could access mental health services he responded:

You would have to either hurt yourself, or someone else, so that they end up in hospital. Marlon

The interviewer asked if it was possible to access mental health services by using less drastic measures, Marlon answered:

Uhm. Naaah. I don’t know. I do not think so. Not from my experience. Marlon

Another sub-group having difficulties accessing mental health services was those in prison for the first time. Most had led more typical lives with stable employment and housing conditions before imprisonment. When they sought mental health services, they were told that these adjustment problems were normal in prison:

I’ve been struggling for several periods here and have said that I wanted to talk to a nurse or a psychologist. And then I was referred to a psychologist. And the psychologist assessed me, and said that: “Nothing’s wrong with you, you are just having a hard time, I cannot help you”. So, you do not get anyone to talk to, unless you- I don’t know what you must have really, but I sure ain’t got it. The nurses say that they haven’t got the time, and the psychologist says that I am not ill. And then I am left to feel bad. In my case, there is no service really. Stuart

Prison officers’ role in mental healthcare and accessing services

Several participants stated that mental health problems and well-being were not high on the prison agenda. Many would have appreciated it if correctional officers on a more regular basis had asked how they were doing and believed that this would have facilitated them to open up and talk about mental health issues.

In my opinion, mental health is forgotten here in a way. Physical activity, movement, workouts, yes. Since I arrived here some months ago, only twice I’ve been asked: “Hi, how are you? Is there something you want to talk about?” Travis

Some also said that they knew people in prison who were unaware of their own need for mental health care or unable to access help, and argued that the correctional system should do more to help these people to access care:

You have the type where people do not get help because they themselves are not able to request help from the prison health services and the prison officers do not see to that they get the help they need. Neil

Some were concerned about how acute health problems were handled in the weekends and evenings when prison health services were unavailable. In these situations, prison officers were left to decide whether or not to contact emergency healthcare services. Several of the participants were not satisfied by this arrangement:

(…) they think that they can make a doctor’s judgement. That they can decide that it is not that important. It is rude. It is trespassing norms. Jack

Some participants told stories of how their peers in prison did not seem to get the help they needed even though it was apparent that they were in a bad state mentally:

I have reported concern about people, before they started cutting themselves and f***ing themselves up. But what worries me, is that even though I voiced my concern to both prison health services and prison officers, no measures were taken. Before it was too late. Stuart

Asking for help from correctional officers could also have consequences. Ronny served at a lower security level. He experienced that his requests to see a psychologist were met by suggestions of transferring him to a higher security level:

I have written request forms: “I need to speak to a psychologist. Immediately”. And then they [the prison officers] are threatening me by saying that they are going to transfer me to a higher security level. They ask if I am going to hurt myself. No, I tell them. I’m not going to hurt myself. I just need to talk to a psychologist. Ronny

Another participant described how he had sometimes cut himself by shards from plates and drinking glass to suppress mental suffering. He explained how he on one occasion used the intercom to notify the officers that they needed to come and pick up a glass that was triggering an urge to self-harm. The participant said that initially a single officer came to his cell to pick up the glass:

A few minutes later there were four officers, and they unlocked the cell door, and there were a lot of questions. I guess they were worried about my mental state, and I said that I appreciated the concern. Then I reminded them that I had asked them to pick up the glass so I would NOT cut myself, so if they were to use that against me, it would be unfair. Tommy

He reassured that the situation had been resolved with the conversation. However, he had the impression that disclosing mental distress to officers could increase the risk for being transferred to a higher security level, or to a security cell.

Enhancing access to services

The perceived advantages of seeking professional help.

There were some commonly experienced benefits of seeking mental healthcare among the participants. Coming off drugs and living under stable conditions in prison provided some participants an opportunity to reflect on their lives and to gather motivation to work on their addiction and mental health problems:

I have been thinking a lot about treatment in an institution. I know how it went the last few times I got out [of prison]. Within half an hour I was sitting there with the needle. And if I don’t do anything before I get out, the same will happen again. I’m trying to prevent it (…) I’ve had treatment for drug and alcohol use before. And back then there was a psychologist who said that, once you’ve been clean for a year, then the brain is back to normal. I can feel it, like, my mindset is already changing . Kurt

For about half of the participants, seeking professional help was related to their motivation for living a law-abiding life after prison. The participants linked substance use to both mental health problems and a criminal lifestyle, and getting treatment was seen as essential for preventing recidivism:

I have lived a rough life, and I have no-one, NO-ONE. How long am I going to live? One doesn’t know. But I’ll be fifty soon. So, I must make it now. I really have to make it now [his voice bursts]. And it depends on many psychological factors. So, I’m choosing to use all the things that I have access to in prison, like treatment for drug addiction. Roy

Although many had previous experience of treatment for their substance use, they still had hopes that treatment could help them. Liam had previously experienced that consultations with a psychologist brought up subjects that was difficult for him to talk about:

I regret that I quit, because it could have done me good. But I guess it got too personal, and it stirred up things. Liam

He also explained that at the time he was more interested in doing drugs than going to therapy. However, he still believed that treatment could help him:

I will probably contact a psychologist, now that I’m about to get treatment for my addictions. It is easier to open up when there are no substances involved. Liam

In summary, seeking professional help for mental health problems was perceived to promote in-prison coping, rehabilitation, and preparation for life outside of prison for most of the participants.

Lowering the bar for accessing mental health services .

Many of the participants expressed skepticism towards ‘the system’. They described how they had been let down and disappointed by the child welfare services, the criminal justice system, and healthcare professionals. Experiences from childhood to adult life had led to a lack of confidence that healthcare personnel and the correctional system and society had their best interest at heart. For them, it was important that healthcare professionals were perceived as genuine and “on their side”:

The experience of being believed and listened to… They do not have to relate, to say that they understand so damn much, ‘cause that’s not really important. Marlon

Several participants said that barriers for talking about mental health were reduced when healthcare personnel reached out in the prison ward. One of the prisoners described two nurses who used to visit the prison wing every day at lunch-hour. He appreciated that it was possible to request a private conversation in the cell, and that he was taken seriously:

They were highly skilled. And they listened. They listened to what you had to say, and they understood you. Tommy

Having previous positive experiences of mental health treatment and knowledge of what to expect from mental health services also seemed to reduce barriers for in-prison help-seeking from some of the participants:

I saw a psychologist on a regular basis, once a week (…). And after six consultations I was past the worst in some sense. I was provided with the tools I needed to cope. Bobby .

This participant had experience with psychological treatment outside of prison and had tried to access mental health services for months in prison. However, he believed his challenges were too mild to get help from a psychologist. He emphasized the need for available low-threshold services for those who suffer from milder mental health problems:

It should be available for everyone who wants it. It should not be embarrassing, it should not be taboo, it should be… A natural part of it, really. Bobby

In addition, when services were provided as standard procedure and a natural part of rehabilitation, they were perceived as less stigmatizing. Nicky described how he was placed on a prison ward that was specialized in substance use treatment:

And when you are placed in that ward, then you are automatically assigned to a psychologist from the substance use clinic, that you can have weekly consultations with. Nicky .

Some also suggested that the systematic screening and assessment of health and social problems also could facilitate access to mental health services and this was suggested as an integral part of healthcare and rehabilitation in prison by some of the participants. Ronny underscored the importance of proper assessment:

What is this person’s problem? Why did he come back? Is there something happening to him on the outside? Could he need help with anything? Maybe someone should ask him? Ronny

Ronny went on describing the nice brochures of the correctional system, with promises of assessment of strengths and needs of individuals, but he claimed that this did not happen in reality. This view was shared by several of the other participants, as they called for more assessment to benefit the mental health and rehabilitation of incarcerated individuals.

Mental health support from different sources

The participants had different preferences regarding where to get help. Support from friends and family was seen as important for most of the participants. However, health professionals could sometimes be preferred over informal or semi-formal sources because of their role in advocating for better living conditions in prison:

I get visits from my family, but I’d like to talk to someone here in prison, so that they could gain awareness of the actual problem. If I’m spitting venom to some random lady that is here as a volunteer with the Red Cross, it’s useless, I think. If I talk to a nurse who works here at this establishment, she could perhaps do something about some of our challenges. Stuart

The cultural competency of health care personnel could also be a key factor in promoting help-seeking and forming a therapeutic alliance with people in prison. Many incarcerated individuals have lived on the edge of society, while most health care personnel, and particularly doctors and psychologists, are from the upper middle class. These cultural differences may form an abyss between the incarcerated individuals and mental healthcare personnel:

A psychologist does not have a criminal record. Now I’m generalizing. But they have performed well in school. Have passed through the system. Highly educated. Their lives have been smooth sailing (…) They have not experienced the shadow side of life. Tommy

This participant had one prior positive experience with a psychologist, but his general impression of psychologists was that they were of no help. He did not feel a connection with any of the others and had written them off completely. He preferred talking to a representative from a user organization who have led a similar life to himself:

I know that they know exactly how I’m feeling. They have served a prison sentence. And they… They have lived experience, and then it’s much easier to listen to what they have to say, because I know it’s not knowledge that they have acquired through reading. Tommy

Prison officers can also be of help to incarcerated people who experience mental health problems. Nicky said that while he was at a lower security level, he had been to a sports event outside prison with an officer and some fellow incarcerated. He had a panic attack because of all the people who kept arriving at the venue and he had to go outside for some fresh air. The prison officer followed him and was understanding, and told Nicky that he had seen many incarcerated people with similar reactions:

He was understanding and said: It will be OK. After that day at the match, coincidently, he ended up being my primary contact officer. And to socialize me back to society he fixed it so that every weekend he was working we could go to a shopping mall, to try. Little by little, by little. (…) It helped. It did. Yes. Nicky

Although Nicky had no plan to seek help for his anxiety symptoms, he appreciated the support he received from his primary contact officer.

Bobby, on the other hand, had some informal support from fellow incarcerated and had also talked with a priest. He said that he often ruminated when he had time alone in his cell and emphasized his need for sharing his thoughts with others and receiving advice. He explained why he preferred to get help from formal sources:

So, to have someone who is an outsider. Who’s not an inmate. Who has got a sensible outlook on life, that can guide you– I think that’s important. (…) Because when you talk to a fellow inmate, then… It can go in the opposite direction, right. Because many have been through major crises, they have lost friends, they have lost family, maybe they have lost their girlfriend and wife, their children won’t speak to them, right? Bobby

Most participants also held the prison priests in high regard and appreciated the availability of the service. However, talking with a priest was not seen as a replacement for a consultation with a psychologist:

It was peculiar, when I asked for someone to talk with, the priest was offered first. For me it is alright, I go to church. But I’m thinking, if someone is not a Christian. I’m like: a priest? Or if you’re not religious. A session with the priest is more like a consultation towards God and his will. He can be a good listener [the priest], but you might not get the help you need in a mental sense. So, a psychologist, a “talking person” in prison is necessary. That could check on you sometimes.

This study’s findings demonstrate that many of the factors deciding access to mental healthcare are firmly rooted at the organizational level of the correctional and healthcare systems. Prisons in the Scandinavian countries, including Norway, are presumptuously humane compared to harsher correctional settings in other parts of the world. One could assume that these favorable conditions would be more conducive to mental healthcare access. However, the systemic barriers we found largely overlapped with challenges reported in other countries [ 42 , 43 , 44 ]. In addition, we found that individual beliefs, attitudes and aspirations also influence willingness to seek mental healthcare. Interestingly, most of these intrapersonal factors are tightly interwoven with the participant’s appraisals of how the prison conditions influence their mental health. This study also addresses an important knowledge gap in the literature, namely how restrictions on access to mental health information could influence mental health help-seeking for people in prison. The identified core category, “Breaking down barriers”, reflects an overarching focus on solutions to improving mental healthcare access based on the experiences of the participants in this study.

Access to health information

Knowledge of available services and how to access them is a prerequisite for mental health help-seeking [ 80 ]. The participants in our study claimed that information about mental health services was unsatisfactory, and lack of such information has also been noted as a barrier to help-seeking in other prison-based studies [ 44 ]. Moreover, sufficient levels of mental health literacy are positively associated with increased intentions for help-seeking from both informal and formal sources [ 81 ]. The participants in our study reported severely restricted access to their preferred sources of health information and a dependency on others to obtain such information. Since information seeking may occur before individuals are ready to share their health concerns with others, having to rely on others for accessing information is a potential barrier for recognizing mental health problems [ 25 ]. Thus, it is likely that the limited access to mental health information negatively impacts incarcerated persons capacity to manage their own mental health needs. The potential consequences of restrictions on access to health information among people in prison need more research attention. However, findings from other populations suggest that closing the apparent health information gap could be an important intervention for improving help-seeking for mental health problems [ 82 , 83 ].

The social influences on accessing mental healthcare

The participants reported that prison culture reduced their willingness to seek support from fellow incarcerated and the use of professional help for mental health problems. The TBP element “subjective norms” posits that beliefs about the opinions of others may influence the willingness to seek help [ 29 ]. Attributing mental health problems to personal weakness may reflect a stereotyped attitude involved in stigmatizing mental disorders [ 84 ]. Stigma may lead to concerns about what others might think if one were to seek help, and may delay or hinder help-seeking efforts [ 80 , 85 ]. It also seemed to be an important constraint to mental healthcare access in our study. This corresponds with findings from other studies [ 45 , 46 , 47 ] and suggests that fear of appearing weak is also a significant barrier to help-seeking in a Scandinavian prison context. Based on our findings and recommendations, we advise that focus on health education and normalization of mental health problems are measures that could decrease stigma [ 86 ], and increase willingness to seek mental health support and treatment among people in prison.

Although the culture among those incarcerated was perceived to discourage seeking support for mental health problems, fellow incarcerated also played a key role in supporting those who experienced mental health problems. They were more available than other help sources and had lived experience with distress related to imprisonment. Since information about available services was insufficient, fellow incarcerated were also perceived as an important source of information. Thus, naturally occurring peer support seemed to normalize mental health problems, possibly reducing stigma and lowering the threshold for mental health help-seeking. From the literature, we know that peer-based health interventions is effective in correctional settings [ 87 ], and formalizing peer-based health information and support could be beneficial in interventions aiming to increase the use of mental health services.

Beliefs and motivations for help-seeking

The prison environment was embedded in the participants’ beliefs: attributing the onset and worsening of mental health problems to the prison conditions was common among the participants. According to the Theory of Planned Behavior (TPB), attitudes about the potential benefits of help-seeking and alignment with individual goals affect the readiness and willingness to seek professional help [ 29 ]. Our data supported this notion. Some participants abstained from seeking professional help as they did not see how it might benefit them in their goal of improving their living conditions. For others, a prominent motive for seeking professional help was to receive validation and help managing their challenging life situations and the everyday stressors of prison life. A few participants also framed mental health help-seeking as a mission to document the consequences of imprisonment. By sharing their experiences with professionals, they hoped healthcare personnel could help them advocate for better conditions in prison. Obtaining sufficient knowledge about essential aspects of prison life is essential for health professionals working in a prison setting [ 88 ]. Based on our findings we propose that the ability of healthcare staff to communicate their understanding of the influence of prison living conditions on mental health is crucial for gaining trust and building an alliance with their incarcerated patients.

Another important motivator for many participants seeking help was their aspirations to live a law-abiding life after being released. It has been increasingly recognized that the relationship between mental disorders and criminal activity is complex and that integrated treatment that addresses both criminogenic factors (i.e. antisocial attitudes and behavior, substance use, criminal network, family issues and low educational/vocational engagement) and mental health issues is a must to prevent recidivism [ 89 ]. This view corresponds with the beliefs and preferences for rehabilitation and healthcare of several participants in our study. They were worried about their reintegration into society, which motivated them to seek professional help. Substance use treatment, in particular, was seen as essential to attaining rehabilitative goals. However, some participants who had served multiple sentences were less positive towards help-seeking. They had more negative experiences and seemed less hopeful that mental healthcare could improve their situation. Their low expectations for potential gain combined with a perceived lack of personal control in the help-seeking process, appeared to stall help-seeking for these participants. We suggest that implementing health services with a concurrent focus on addressing both criminogenic needs and mental disorders could be especially important for fostering healthcare utilization for people with a history of reoffending.

Organizational barriers to accessing mental healthcare

The perceived challenges with the paper-based request system were considered a significant barrier to healthcare access. TPB postulates that behavioral control and self-efficacy are important in help-seeking [ 29 ]. In a system where autonomy is limited, one could assume that a self-referral system can be empowering for those seeking help. However, the participants seemed to experience the opposite as they were left passively waiting for an answer to their request. Some also expressed confidentiality concerns, as they believed that prison officers read the request notes. Thus, the process of accessing health services seemed to diminish, rather than enhance their notions of control and self-efficacy. Improving the reliability of responses to requests and ensuring confidentiality could increase the experience of control in the self-referral process and may also empower imprisoned persons to seek help.

A barrier rooted in the interactions between the individual and the helping services was found in various expressions of skepticism towards “the system” by many participants. Earlier studies have also reported distrust in the system as a barrier to help-seeking [ 41 , 44 ]. Our results elaborate on these findings as the participants spoke of how suicides and severe self-harm by fellow incarcerated people contributed to diminished faith in the system. Some had voiced concern over the health and welfare of peers and had experienced that they were not listened to by the prison officers. According to the participants, many of their fellow incarcerated people had more severe symptoms of mental health problems and did not seem to have access to the help they needed. This confirmed their beliefs that the system took little interest in their mental health, and for some of them this led to a growing feeling of hopelessness and resentment. In addition, the high prevalence of mental disorders in prison implies that incarcerated persons witness people in severe distress regularly and for prolonged periods. This issue is largely unexplored and unrecognized in prison research, and the impact of these experiences on mental well-being and recovery should be investigated further.

Participants who experienced mental distress and adjustment problems had difficulties in accessing mental health services. They needed someone to talk to about their situation that could give them advice on how to cope, however they did not fulfil the criteria for secondary mental health services. Minor mental health problems in Norwegian prisons are to be handled by the prison healthcare services. However, according to the participants their capacity is very limited. This finding corresponds to other studies [ 90 ] documenting that access to integrated mental health services was limited for those with milder mental health problems. In the community, the establishment of low threshold services for people with mental health problems has been an important commitment as early intervention can prevent the development of more serious conditions. This may be even more important for those imprisoned, since coping strategies such as physical activity and seeking social support are less accessible [ 91 ].

Prison officer’s influence on access to mental healthcare

Prison officers were perceived to have a key role as gatekeepers to healthcare. Officers can facilitate access to healthcare by encouraging help-seeking or directly contacting healthcare services based on observations and conversations with incarcerated individuals [ 39 , 41 , 92 ]. The participants in our study pointed out the need for prison officers to take their health concerns more seriously, and that the threshold for contacting healthcare services by their request was too high. In addition, being asked directly about their psychological state by staff members was seen to ease talks about mental health by the participants. Our results support the notion that prison officers that are responsive to the mental healthcare needs of incarcerated persons could build confidence that these needs would be attended to when required [ 92 ]. Thus, ensuring sufficient mental health knowledge and awareness among prison officers of their role in mental healthcare access is an essential task for correctional systems.

Previous studies have found that the correctional systems´ procedures for managing suicidal risk is a potential obstacle for help-seeking. The fear of being moved or placed in a safety cell without personal belongings was identified as a barrier to disclosing suicidal thoughts [ 39 , 93 ]. In Norway, the risk of self-harm and suicide is ideally handled by increasing social contact, activities, monitoring and healthcare. However, in the face of acute mental crisis and severe suicide risk, placing persons in solitary confinement is not an uncommon practice [ 94 ]. Challenges with having incarcerated persons admitted and treated in specialized health care institutions, understaffing, and a lack of central guidelines for handling suicide risk may contribute to the use of solitary confinement for incarcerated persons in acute mental distress in the Norwegian correctional system [ 94 ]. The Norwegian Parliamentary Ombudsman reports that fear of solitary confinement and being placed in a security cell is a barrier to seeking help for suicidal ideations and plans [ 95 ]. In our study, participants who had asked for help when they were in acute distress experienced that the officers assumed that they intended to harm themselves. They were faced with the potential of being transferred to a higher security level or being placed in solitary confinement. Thus, how prison officers respond to incarcerated persons’ reports of acute mental distress could be of critical importance for their willingness to seek help for mental health issues in the future. However, more research on the perceived and actual consequences of disclosing mental distress and suicidal ideations in prison is needed to inform interventions to promote help-seeking.

Enhancing access to mental healthcare in prison

The participants underscore some conditions that may lower the bar mental healthcare utilization. Earlier positive experiences with mental healthcare in the community was mentioned by participants as important for their willingness to seek such services in prison, which also corresponds with findings in earlier studies [ 42 , 96 ]. In addition, the participants saw mental health services that were outreaching and integrated as positive. A few participants also highlighted mental health screening at reception to discover mental disorders that may need intervention. Screening at intake, and outreaching and integrated services are also recommended in the prison research literature [ 88 ]. Our findings show that these recommended measures may also make intuitive sense to incarcerated persons - common for all of them are that they seem to reduce stigma related to utilizing mental healthcare.

Our results indicate that incarcerated persons with both milder and more severe mental disorders experience barriers to accessing mental healthcare. These results are in line with studies from other correctional settings reporting unmet needs due to challenges with access and delivery of mental healthcare [ 37 , 38 , 39 ]. The underutilization of mental health services by incarcerated persons suggests that the ‘degree of fit’ between their needs and the available mental healthcare requires improvement. The World Health Organization (WHO) advocates for correctional systems with health and well-being as an integrated part of their core business and culture [ 33 ]. Along these lines, we found that participants called for a correctional system with mental health higher on the agenda. Some also preferred to seek help for mental health problems from other sources than mental health professionals. This finding supports the recommendation of the WHO that it is important to build mental health competency in all staff members in contact with those imprisoned. As many of the barriers to mental healthcare utilization are rooted in the wider correctional setting, we also suggest that the correctional and healthcare systems, in collaboration, should review their practices to enhance perceived efficacy in accessing healthcare.

Limitations

The data in this study are based on interviews with fifteen participants from three prisons. The participants were self-selected and may have had more knowledge, interest, and willingness to talk about mental health issues than the average person in prison. We cannot claim that the results represent a complete account of access to mental healthcare and help-seeking among incarcerated persons in Norway. However, our findings were consistent with findings from other studies from Norway and correctional settings in some other countries. We have presented details about the participants, method, data, and context to allow others to consider the potential transferability of the results. We hope our findings encourage further research on access to mental healthcare for people in prison.

Mental healthcare that is outreaching and integrated is perceived to facilitate access and decrease stigma. The correctional system should address access to health information, the referral system, and their responses to incarcerated persons who disclose distress to facilitate access to healthcare. Our results also indicate that mental healthcare extends beyond the scope of health services, suggesting that sufficient mental health knowledge and agency is needed at all levels of the correctional system.

Data availability

The data produced in the course of this research is not openly accessible owing to considerations regarding privacy. However, they can be obtained from the corresponding author upon a reasonable request.

Abbreviations

Theory of planned behavior

Mental health literacy

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Acknowledgements

The authors thank the study participants and the correctional facilities for their cooperation.

Open access funding provided by UiT The Arctic University of Norway (incl University Hospital of North Norway). The study was supported by a grant from the North Norway Regional Health Authority (Helse Nord RHF). The funding body had no role in study design, data collection, analysis, or writing of the manuscript. The study was supported by the Publication Fund of UiT The Arctic University of Norway.

Open access funding provided by UiT The Arctic University of Norway (incl University Hospital of North Norway)

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Svein Bergvik

Department of Education, ICT and Learning, Østfold University College, Tromsø, Norway

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All authors contributed to the conception and design of the study. LES conducted the interviews and their transcription. All authors analyzed the data. LES drafted the manuscript. All authors participated in revising the manuscript and approved the final version.

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The study was performed in accordance with the Declaration of Helsinki. All relevant guidelines and regulations were followed. All participants gave written informed consent. The study was approved by the Data Protection Officer of the University Hospital of North Norway. The Norwegian Correctional System, Region North, also approved the study. The study was submitted to and deemed outside the mandate of the Regional Health Research Ethics Committee of Northern Norway.

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Solbakken, L.E., Bergvik, S. & Wynn, R. Breaking down barriers to mental healthcare access in prison: a qualitative interview study with incarcerated males in Norway. BMC Psychiatry 24 , 292 (2024). https://doi.org/10.1186/s12888-024-05736-w

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Accepted : 03 April 2024

Published : 17 April 2024

DOI : https://doi.org/10.1186/s12888-024-05736-w

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