Chapter 8: Qualitative Research in Healthcare

Sitaji Gurung

Learning Objectives:

• Define the purpose and significance of qualitative research in healthcare settings.
• Identify and compare various qualitative research methods such as interviews, focus groups, case studies, and observations.
• Evaluate the strengths and limitations of each qualitative method in different healthcare contexts.
• Understand key ethical considerations in conducting qualitative research.
• Apply knowledge of qualitative methods to interpret findings for evidence-based decision-making.

Qualitative research is essential in healthcare for exploring complex human experiences, behaviors, and systems that cannot be captured by numbers alone. It helps researchers understand how patients, providers, and communities perceive and interact with health systems, policies, and interventions. Unlike quantitative research, which seeks to measure and predict, qualitative research emphasizes meaning, context, and depth. In healthcare settings, it is often used for program evaluation, needs assessments, and informing policy decisions. This approach ensures that healthcare solutions are grounded in real-world experiences and human-centered insights.

Discussion Questions

1. Why is qualitative research especially important in healthcare settings?
2. How does qualitative research differ in purpose and method from quantitative research?

Purpose and Significance of Qualitative Research

Qualitative research serves multiple purposes in healthcare. It informs program design, enhances patient-centered care, and supports policy development. It is particularly valuable in uncovering the “why” and “how” behind observed phenomena. For example, understanding patient noncompliance with medications may require interviews that explore personal beliefs, cultural contexts, and socioeconomic barriers. The significance of qualitative research lies in its ability to generate rich, narrative data that illuminate lived experiences and social dynamics, which are often missing in numeric data. It enables healthcare professionals to make informed decisions that respect patients’ voices.

Discussion Questions

1. What types of healthcare decisions can be improved with qualitative insights?
2. What are some challenges in using qualitative data for policy development?

Interviews: Capturing Personal Narratives

Interviews are a foundational method in qualitative research, offering detailed and individualized insights. They may be structured (using a fixed set of questions), semi-structured (guided by themes), or unstructured (free-flowing conversations). In healthcare, interviews are used to explore patient experiences, provider perspectives, and the impact of interventions. This method is flexible and allows researchers to adapt questions based on the conversation, making it possible to probe deeply into sensitive or complex topics. While time-consuming, interviews generate rich data that can uncover trends, attitudes, and unmet needs.

Discussion Questions

1. When might you choose a semi-structured interview over a structured one?
2. What types of healthcare questions are best suited to interviews?

Focus Groups: Exploring Shared Experiences

Focus groups involve facilitated discussions with 6–10 participants who share similar backgrounds or experiences. They allow researchers to explore collective perspectives and interactions in a social context. In healthcare, focus groups are useful for understanding patient satisfaction, community health needs, or staff feedback. They reveal group norms, consensus, and disagreements, offering insight into social influences on health behaviors. The group setting can also encourage participants to build on each other’s ideas. However, dominant voices may overshadow quieter participants, and privacy is more difficult to maintain.

Discussion Questions

1. What are the advantages of using focus groups over one-on-one interviews?
2. What strategies can be used to encourage all participants to speak?

Case Studies: In-Depth Analysis of Complex Situations

Case studies offer an in-depth examination of a specific individual, group, or organization in its real-world context. They are ideal for exploring unique or complex healthcare scenarios, such as rare diseases, innovative programs, or policy implementations. Case studies integrate multiple data sources such as interviews, documents, observations, to provide a holistic view. This method is particularly valuable when generalization is less important than understanding the nuance and richness of a single case. Despite limitations in scope, case studies generate detailed knowledge applicable to similar settings or issues.

Discussion Questions

1. What makes a case study design especially useful in healthcare research?
2. How can multiple data sources improve the credibility of a case study?

Table 1: Comparison of Common Qualitative Research Methods

Method	Description	Strengths	Limitations
Interviews	One-on-one conversations	Deep personal insights	Time-consuming; limited generalizability
Focus Groups	Group discussions on shared topics	Reveals group norms and dynamics	Risk of dominant voices; limited privacy
Case Studies	In-depth analysis of a case	Holistic understanding; multiple data sources	Limited generalizability
Observation	Watching people in natural settings	Context-rich data; real-time behaviors	Observer bias; may miss internal experiences

Observation: Understanding Contextual Behaviors

Observation allows researchers to witness behaviors, interactions, and environmental factors in real time. It can be participatory (the researcher engages in the setting) or non-participatory (the researcher observes without involvement). In healthcare, this method is used to study workflows, patient-provider interactions, and organizational culture. Observation captures data that participants might not articulate in interviews or surveys. However, ethical challenges such as consent and observer influence must be carefully managed. Observations are especially useful for evaluating practice settings or testing the implementation of new protocols.

Discussion Questions

1. When is observation more useful than interviews or focus groups?
2. What are the ethical concerns when conducting observations in clinical settings?

Choosing the Right Approach

Each qualitative method has unique strengths and weaknesses. Selecting the appropriate approach depends on research goals, context, resources, and ethical considerations. For instance, interviews are ideal for personal narratives, while focus groups excel at capturing community voices. Case studies provide depth, and observations offer real-time insight. Often, researchers combine methods (triangulation) to strengthen their findings. Choosing the right approach ensures the research captures the most relevant and trustworthy data for healthcare decision-making.

Discussion Questions

1. What factors should be considered when selecting a qualitative research method?
2. Why might a mixed-methods approach be valuable in healthcare evaluation?

Ethical Considerations in Qualitative Research

Ethical practices are central to all research, but qualitative work presents unique challenges. Researchers must obtain informed consent, maintain confidentiality, and ensure voluntary participation. The flexible and interactive nature of qualitative methods requires ongoing ethical vigilance, especially when discussing sensitive topics. Protecting participants from harm, respecting their stories, and receiving IRB (Institutional Review Board) approval are essential. Researchers must also be reflexive, aware of how their own backgrounds and assumptions influence the process.

Discussion Questions

1. How can a researcher ensure informed consent in an evolving interview?
2. Why is reflexivity important in qualitative healthcare research?

Data Evaluation and Interpretation

Once data are collected, qualitative researchers can code and interpret it to identify patterns and themes. Unlike statistical analysis, qualitative data analysis involves reviewing transcripts, notes, and recordings to extract meaning. Coding may be manual or assisted by software (e.g., NVivo). Themes are developed through repeated readings and comparison across cases. Interpretation is guided by research questions, theoretical frameworks, and participant voices. The goal is not just to describe but to explain, offering actionable insights grounded in participant experiences.

Figure 1: Steps in Qualitative Data Analysis

Discussion Questions

1. What is thematic analysis, and why is it important?
2. How can researchers ensure their interpretation is accurate and unbiased?

Communicating Findings and Evidence-Based Decisions

Clear communication of qualitative findings is critical for impact. Researchers often use direct quotes, narrative summaries, and visual models to convey participant voices. Findings should be presented in a way that informs policy, guides practice, or improves programs. In healthcare, qualitative research supports evidence-based decisions by contextualizing numerical trends with real-world meaning. Whether published in reports, presentations, or academic journals, qualitative findings must be accessible, respectful, and relevant to stakeholders.

Discussion Questions

1. What makes qualitative findings useful for healthcare professionals and policymakers?
2. How can researchers present qualitative results to non-expert audiences?

A Simulated Case Study: Using Qualitative Research in a Clinic

A community clinic conducted focus groups with patients to understand low turnout for cancer screening events. Participants revealed fears of diagnosis, logistical challenges, and distrust of medical staff. These insights led to scheduling changes, outreach through trusted community members, and better patient education. As a result, participation improved by 30% over six months. This case demonstrates how qualitative research directly informed actionable, patient-centered improvements.

Discussion Questions

1. How did qualitative research contribute to improving screening turnout?
2. What could be done to follow up on these focus group findings?

Key Terms

Qualitative Research – An approach focused on exploring meaning, context, and human experiences.

Interview – A method involving direct conversations between a researcher and participant.

Focus Group – A group discussion used to gather opinions, beliefs, and attitudes.

Case Study – An in-depth examination of a specific individual, group, or situation.

Observation – A technique involving watching behaviors and interactions in real settings.

Participant Observation – When the researcher actively engages in the environment being studied.

Non-Participant Observation – The researcher observes without involvement.

Thematic Analysis – A process of identifying patterns or themes in qualitative data.

Coding – The process of labeling and organizing data into meaningful categories.

Triangulation – Using multiple methods or data sources to enhance research credibility.

Informed Consent – Participants’ agreement to join a study after being fully informed.

Confidentiality – Protecting participants’ identities and data.

Ethics Review – Approval process by a research board to ensure study ethics.

Reflexivity – The researcher’s awareness of their own role and impact on the research.

Evidence-Based Decision Making – Using research findings to inform healthcare actions and policies.

References

Mack, N., Woodsong, C., MacQueen, K. M., Guest, G., & Namey, E. (2005). Qualitative research methods: A data collector’s field guide. Family Health International.

Pope, C., Ziebland, S., & Mays, N. (2000). Qualitative research in health care: Analysing qualitative data. BMJ (Clinical Research Ed.), 320(7227), 114–116.

Giacomini, M. K., & Cook, D. J. (2000). Users’ guides to the medical literature: XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? JAMA, 284(4), 478–482.

Renjith, V., Yesodharan, R., Noronha, J. A., Ladd, E., & George, A. (2021). Qualitative methods in health care research. International Journal of Preventive Medicine, 12, 20.

St. Jacques, L. (2022). Qualitative methods in healthcare research [Video]. Canadian Association of Physician Assistants.